Please list the brand of products you are currently using, if applicable:
I agree that the all of information listed above will be reviewed and presented with my clear understanding of what this procedure involves. All of my questions will be addressed.
This information will help your esthetician to better evaluate your skin type so that your laser treatment will be more effective. Skin type is determined genetically and includes the color of your eyes, hair, etc. The way your skin responds to sun exposure is another way of correctly assessing your skin type. Recent tanning, whether by sun or an artificial tanning booth, even tanning creams, can have a major impact on your skin.
(pick the description that best fits you):
(pick the reaction that best fits you):
(pick the habit that most applies to you):
Laser Hair Removal Policy and Guideline Consent
, am aware that there is a specific guideline for laser hairremoval at Columbia Laser & Aesthetics that I will need to follow as listed below to obtain permanenthair reduction.
Please thoroughly read and initial beside each statement:
I understand that my esthetician recommends a minimum of 9 laser hair removal treatments per area for all patients (regardless of any previous treatments at another facility) for best results. I understand that laser treatments are sold in packages of 3.
I understand that only after I have paid for and received all 9 treatments per area at Columbia Laser & AestheQcs am I eligible to receive a maximum of 3 complimentary follow-up appointments.
I understand that to see optimum results I will need to stay on a consistent schedule as advised by my esthetician (typically 4 weeks for smaller body parts, or 8 weeks for larger body parts) I am aware that if I do not stay on the schedule my esthetician recommends, I will not see results.
I understand that I am not to have any prolonged exposure to the sun or use any form of tanning (including self-tanners, spray tans, and tanning beds) 2 weeks before and/or 2 weeks after each of my scheduled appointment dates. I am aware that failure to avoid sun or tanning can result in adverse reactions such as hyper/hypopigmentation and/or burning of the exposed area(s).
I understand that I will not be able to have laser hair removal treatments if I have been on an antibiotic or have been taking any medications with a photo/sun sensitivity within the past 10 days (you will need to be scheduled for 10 days after the last day of taking such medications).
*Please note, if you have any questions you may ask your esthetician during your scheduled appointment time.
Laser Treatment Consent Form
Please read and initial after each paragraph:
I am 18 years of age or older, or I am accompanied by a parent or legal guardian who will consent for me to have this treatment.
I acknowledge that the laser is a device that produces an intense but gentle burst of light. With this light, there is a minimal amount of risk. These risks (listed below) are typically associated with prolonged exposure to sunlight or use of a prohibited medication.
I understand that the following are possible risks and complications of this procedure including but not limited to:
I understand that my eyes will be covered with laser-specific safety eyewear or an opaque material to protect them from the intense light. My eyes will be closed and I will not aempt to remove the eye protection during treatment.
I understand that complete clearing of my spider veins, brown spots, or redness may not be possible and will depend upon the type, age and color of the trouble spot. multiple treatments may be needed for the best results.
I understand that other methods of treating this condition will be discussed with me if I request, such that I may assess the risks and benefits of these alternative treatment methods.
I understand that anesthesia is usually not necessary. My provider or I may elect to use a form of topical anesthesia to reduce any discomfort during the procedure. A cryogen spray skin cooling device may be used during the procedure to decrease discomfort and protect the skin. All anesthesia options and risks will be discussed with me in advance if I choose to use.
I understand that immediately following the laser treatment redness, swelling, discomfort, whelping, bruising, and discoloration may develop at the treatment site. I understand that any discoloration may last 7-14 days and swelling should resolve within several days. Discomfort may betreated with the application of cool compresses or topical soothing agents.
I understand I will be given complete instructions regarding after-care of the treated area. It is important to follow aftercare instructions carefully to minimize the chance of incomplete healing, skin textural changes or scarring. This includes, but is not limited to, avoiding sun exposure and tanning.
I have answered all questions about medical history and medications honestly and completely.
I am not pregnant (female patients).
I understand I will be given the opportunity to ask questions about the procedure and the procedure will be discussed in detail with me.
I recognize that the practice of medicine is not an exact science and acknowledge that no guarantees have been made to me concerning the results of such procedures.
I have read and understood all information presented to me before signing this consent form.