HAIR LASER REMOVAL CONSENT FORM

PATIENT INFORMATION:

First Name

Last Name

Date Of Birth

Phone/Mobile

City

Next Of Kin

Kins Contact Number (Phone/Mobile)

MEDICAL HISTORY

Do you have a history of skin disorders or infections?

Yes

Do you have a history of keloid scarring

Yes

Pregnant or breastfeeding?

Yes

Do you have any other medical conditions?

Yes

Your other conditions

Procedure Description:

I understand that I am receiving laser hair removal treatment. Laser hair removal is a non-invasive procedure that uses concentrated beams of laser light to target and disable hair follicles, resulting in long-term hair reduction. It is commonly used to remove unwanted hair from various areas of the body.

Benefits and Risks:

I have been informed that the benefits of a laser hair removal may include:

• Long-lasting reduction in hair growth

• Smoother skin and reduced need for frequent hair removal

• Precision in targeting specific areas

• Potential improvement in ingrown hairs and razor bumps

I understand that there are potential risks and side effects associated with a laser hair removal, including:

• Mild discomfort during the procedure

• Temporary redness, swelling, or itching of the treated area

• Temporary changes in skin pigmentation (lightening or darkening)

• Rarely, blistering, scarring, infection, or burns (typically temporary and treatable)

Aftercare:

I agree to follow the post-treatment instructions provided by the clinician to ensure the best possible results and minimize any risks. I understand that failure to adhere to these instructions may increase the likelihood of complications.

Consent for Treatment:

I hereby consent to undergo a laser hair removal treatment. I acknowledge that the clinician has explained the procedure, its benefits, and potential risks to me. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction. I understand that the results of a laser hair removal can vary, and multiple sessions may be required for optimal results.

Release of Liability:

I release Thrive Aesthetics, its employees, and representatives from any liability associated with the laser hair removaltreatment, except for cases of negligence or intentional misconduct.

Pictures or Videos will be obtained for medical records. If pictures are used for education and marketing purposes, all identifying marks will be cropped or removed.

Initial

I agree that all the above information is true and accurate to the best of my knowledge

Client’s signature: