Laser Hair Removal Intake Form

Introduction

Please SHAVE the night before your appointment.

Laser (Hair Removal) Treatments are advanced, proven, high-tech hair removal procedures. Published studies indicate that Laser Treatments can significantly reduce the appearance of unwanted hair with very little maintenance.

Laser treatment consists of directing laser energy at the skin. The energy disables the growth center of the hair, called the hair follicle. This is possible through a “selective photothermolysis” process, whereby the energy injures only those tissues around the target, which is absorbed by it. The shaft is pigmented cells at the base of the hair follicle and hair. The light emitted from the laser has a specific energy level and lasts a specific duration such that the pigment in the hair follicle maximizes its absorption. When the energy is absorbed, the heat released is sufficient to disable the hair follicle, which interrupts its ability to produce a hair shaft (selective photothermolysis). While delivering the energy to the hair follicle, it is important to cool the skin to avoid injury. An advanced cooling crystal is integrated into the applicator to ensure comfort and safety.

Following Laser (Hair Removal) treatments, there may be a minor degree of redness and puffiness to the skin, with some tingling discomfort that usually disappears within 1 hour to 2 days. You may apply makeup, body lotion and sunscreen immediately and return to your regular daily activities with no “downtime”. It is advisable to avoid hot showers, saunas or excessive sweating for a few hours post-treatment to avoid irritation. It is highly recommended you discuss a maintenance program to maintain the cosmetic improvements you obtain with your Laser treatments.

Before beginning a Laser treatment program you must first attend an Assessment and Information consultation with a Treatment Professional, during which your skin type, hair concerns, expectations and goals will be assessed and discussed. The Treatment Professional will work with you to select the best treatment or combination of treatments for your unwanted hair concerns, expectations and aesthetic goals. The estimated duration and cost of each session or series of sessions will also be provided to you. If you are a candidate, you may schedule your treatments and test spots at the time of this initial consultation.

RISKS ASSOCIATED WITH LASER HAIR REMOVAL TREATMENTS

Although the vast majority of Laser (Hair Removal) treatment clients never experience any of these complications, you should discuss each of them with a Treatment Professional to ensure you fully understand the alternatives, risks, potential complications and average outcomes of treatments.

Discomfort: The Laser (Hair Removal) treatments are very well tolerated in-office treatments. Client comfort may be optimized with the use of topical anesthetic cream and a skin chiller, but the integrated parallel cooling tip on the applicator often provides an acceptable level of comfort during the procedure. With these treatments, you may experience a minor and tolerable degree of heat and/or tingling discomfort with each treatment, especially when many active hair follicles are present.

Skin Wound: It is exceedingly rare for Laser (Hair Removal) treatments to cause a burn, blister or skin irritation/wound. This is more of a risk in darker or tanned skin types. If a burn, blister or skin wound develops it may take 5-10 days to heal, and, in extremely rare instances, may leave a noticeable whitening or darkening of the skin or, even more rarely, a scar. Burns, blisters or skin wounds are much more common if you do not follow the recommended use of sunscreen and avoidance of sunlight, self-tanners, UV light and fluorescent light exposure after treatment.

Scarring: Occurs less than 0.1%. If you have developed a wound and a scar, the scar may end up being flat and white (hypotrophic), large and red (hypertrophic) or extend beyond the margins of the injury (keloid). Subsequent treatment or surgery may be required to improve the appearance of the scar. The scar may be permanent. Not following pre and post-treatment instructions may increase the likelihood of a skin wound or scar.

Pigment Change: With the laser energy used in Velocity (Hair Removal) treatments, there is a small risk of <1% of temporary hyperpigmentation (increased pigment or brown discolouration) or hypopigmentation (whitening of the skin). Usually, these pigment effects are temporary and resolve over several weeks or months. Permanent hyperpigmentation or hypopigmentation is very rare and may occur in less than 1% of cases.

Sun Exposure: Sun exposure to the treatment area immediately after treatment and for one month following the treatment may also increase the risk of pigmentary changes in the treatment area.

Bruising: It is exceedingly uncommon to have any skin bruising following treatment. If bruising occurs, it can be camouflaged immediately and will usually resolve in 8-10 days. As the bruising fades, there may be a rust-brown discolouration of the skin (hyperpigmentation) that may take special creams to fade away.

Infection: Laser (Hair Removal) treatments involve no cutting, surgery or skin penetration, and thus infection is exceedingly rare.

Excessive Redness and Swelling: Rarely, a minor degree of redness and/or puffiness of the skin may follow treatment and usually lasts 1-2 hours. This may persist, in rare instances, for 1-2 days. A mild steroid cream (0.5% hydrocortisone available at the clinic) or ice application, will usually settle this.

Laser (Hair Removal) treatments will leave your skin photosensitized for 48 hours after each treatment and you must avoid sunlight/UV light. Failure to do so could result in significant redness and swelling that may be quite disfiguring and may increase the rare risk of complications, such as blisters, scarring and pigmentation changes.

Fragile Facial Skin (hair removal on the face): The skin overlying the treatment area may become quite fragile. Although uncommon, the fragile skin can become reddened and the outer layer may peel off, much like a blister. This usually settles in 8-10 days. Fragile skin or blisters may be more common if post-care instructions are not followed. If you are subject to cold sores, please notify your Treatment professional, as cold sore eruptions can be common with laser treatments, you may need to go

Skin Type Chart

1. I hereby authorize WayYoung Tech Aesthetics and/or such assistants as may be selected to perform the laser hair removal treatments.

2. I recognize that during the course of the procedure/treatment unforeseen conditions may necessitate different procedures than those above. I, therefore, authorize the above physician and/or assistants or designees to perform such other procedures that are in the exercise of his or her professional judgment necessary and desirable. The authority granted under this paragraph shall include all conditions that require treatment and are not known to my physician at the time the procedure is begun.

3. As part of the requirements, my chart may be subject to a peer review for quality control.

4. I acknowledge that no guarantee has been given by anyone as to the results that may be obtained.

5. For purposes of advancing medical education, I consent to the admittance of observers to the treatment room.

6. I understand that the signature of the witness (if a non-physician) on this document indicates only that the signing of my name has been observed and not that the witness has necessarily provided information regarding the procedure.

7. IT HAS BEEN EXPLAINED TO ME BY MY PHYSICIAN AND/OR ASSISTANTS IN A WAY THAT I UNDERSTAND:

i. THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN

ii. THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT

iii. THERE ARE RISKS TO THE PROCEDURE/TREATMENT PROPOSED

iv. ANY QUESTIONS I MAY HAVE ASKED HAVE BEEN ANSWERED TO MY SATISFACTION