Hair Removal Consent Form Hair Removal Consent Form I clearly understand and accept the following: The goal of this treatment is improvement not perfection. I understand that there will be some hair left at the end of my treatments. The amount of hair that is remaining will be relative to the fluence (energy) that I can tolerate, color, amount and location of my hair. Average hair loss at the end of consecutive sessions is 70-95% less hair. Up to 20% of the population do not respond to any laser and light treatments. This cannot be determined until after the second treatment. There may be more treatments necessary than anticipated. The IPL in studies has shown to reduce hair permanently but results can vary from person to person. I agree to pay the fee quoted and I understand that all fees quoted are non-refundable. Studies and experience with this technology have shown there to be some complications and side effects.-10-20% chance of developing hypo and/ or hyperpigmentation-Purpera, blistering, crusting and possible burning is a risk of this treatment -Freckles and brown spots might lighten and disappear -Purple mottling discolouration can occur with hair removal on legs I understand if I have a history of cold sores or genital herpes I may require pre and post treatment with anti-viral medications. I agree that I have not tweezed, waxed, threaded or had electrolysis for the past four weeks . I agree that I will not tan while undergoing IPL hair removal treatments. I agree to protect my skin with a minimum of 30 SPF for each 4 weeks post treatment. I understand that to have the best results possible I agree to the treatment intervals that Refresh Laser and Wellness has set out for me. I agree to follow post care instructions. I have had the process thoroughly explained to me. I understand and agree that the laser hair removal treatment involves a series and accept the above information throughout the series of treatments. I understand the potential benefits and complications and willingly agree to undergo IPL hair removal treatments to reduce my body hair.* I have read and agree to the terms. Name* First Last Date* Date Format: MM slash DD slash YYYY LocationLocationPitt MeadowsPort MoodyELECTRONIC CONSENTAGREEDISAGREEELECTRONIC CONSENT: Please select your choice below. Clicking on the "agree" button below indicates that: • I have read and fully understand this agreement and all information detailed aboveSignature*SkillsInterestsCAPTCHA
