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:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

Initial

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

Client’s signature: