Laser Hair Removal

Name
Date
Date of birth
Age
Address
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Email Address
Phone
Emergency Contact

M E D I C A L H I S T O R Y

Please mark any of the following conditions you may currently have.

Medial History

I,

Patients Name

I hereby acknowledge that I have voluntarily chosen to undergo a Laser Hair Removal procedure at Beyond Beauty
Medical Aesthetics
I understand that Laser Hair Removal is a non-invasive cosmetic procedure designed to reduce unwanted hair by
using laser technology to target hair follicles.
I have discussed my medical history and skin concerns with my Medical Provider, and I have provided accurate and
complete information. I understand that the success and results of the Laser Hair Removal procedure may vary
depending on my individual skin type and condition.
I freely and voluntarily submit all information requested concerning the state of my health as well as concerning any
medication or drug, prescribed or otherwise, that I am taking; as well as concerning any treatment and/or health or
esthetic treatment that I am currently receiving;
I understand that multiple sessions may be required for optimal results, and the number of sessions will be
determined by the practitioner based on my individual response to treatment. I understand that there may be
potential risks and side effects associated with laser hair removal, including but not limited to:

  • Redness, swelling, and temporary discomfort in the treatment area.
  • Changes in skin pigmentation, such as hyperpigmentation or hypopigmentation.
  • Burns or blisters in rare cases.
  • Scarring, although rare, may occur in certain skin types or with improper aftercare.
  • I understand that the practitioner will provide pre-treatment and post-treatment instructions, and I agree to follow these instructions to ensure safe and effective results.
  • I understand that I should avoid sun exposure and tanning beds for a certain period before and after the treatment to minimize the risk of adverse reactions.
  • I understand that laser hair removal may not be effective for certain hair colors or types and may not lead to permanent hair removal but can significantly reduce hair growth.
  • I understand that there may be a need for maintenance sessions after completing the initial treatment plan to maintain hair reduction.
  • I understand that the cost of laser hair removal may vary based on the treatment area and the number of sessions required.
  • I agree to show up for each treatment according to the schedule and in order to optimize the effectiveness of each treatment.
  • I understand that six to eight (6 to 8) is the average number of treatments for the part of my body being treated (except the face and women going through hormonal change).

By signing this consent form, I affirm that I have read, understood, and received detailed information regarding the Laser Hair Removal procedure, its potential
risks, side effects, and benefits. I acknowledge that I have had the opportunity to ask questions and have received satisfactory answers to all my inquiries.

Patient Name (Printed)
Patient’s Signature *
Printed Name:
Parents Printed Name *
Date:
Parents Signature Date *
Witness Signature:
Witness Signature *
Date:
Witness Signature Date *
Printed Name:
Witness Printed Name *

Y O U R H E A L T H

Have youever hadanallergic reaction to any of the following?

Your Health
If yes to any of the above, please explain

Doyoutakeanyanti-coagulants (blood-thinning) medications?

Haveyouundergone chemotherapy in the last 6 months?

Have you ever had a history of skin disorders, skin cancer, or suspicious skin lesions?

Do you have a family history of skin problems (especially melanomas, skin cancer or vitiligo)?

Do you have any medical conditions that you are currently being treated for?

Are you taking any medications, vitamins, including over-the-counter or prescription drugs?

Are you currently using any herbal supplements that may increase sensitivity to light?

Have you under gone vein surgery on requested treatment area (sclerotherapy, stripping, etc.) ?

Do you have any pacemakers or implanted electronic devices?

Do you have any tattoos or permanent makeup in the treatment area?

Have you ever had a laser hair removal before? If yes, when was your last procedure?

Have you previously under gone any hair removal treatments in the treatment area?

S K I N H I S T O R Y

When where you last exposed to the sun (including tanning booths) ?

Do you have a tan or sunburn in the treatment area?

Do You use sun less tanning lotions? If yes, when was it last applied?

Have you had any recent chemical peels or laser treatments in the treatment area?

Haveyouusedanytopical retinoids ( Retina-A, Renova, Differin) or isotretinoin (Accutane) in the past six months?

Are there any moles, warts, or skin growths in the treatment area?

F E M A L E C L I E N T S

Are youtaking birth control?

Are youpregnant or trying to become pregnant?

Are youundergoing any hormone replacement therapy?

Are your periods regular? With what frequency?

Whenisyournext menstrual cycle due to begin ?

(For your personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.)

Whatservices would you like to perform ?

Facial

facial

Legs / Arms :

legs/arms

Body :

body

Bikini :

bikini

Scope of Practice:
Laser hair removal is a non-invasive cosmetic procedure designed to reduce unwanted hair on various parts of the body. It utilizes a
concentrated beam of light, emitted by a specialized laser or intense pulsed light (IPL) device, to target and destroy hair follicles. The
treatment is commonly used to achieve long-term hair reduction, offering an effective and efficient alternative to traditional hair removal
methods such as shaving, waxing, or plucking.
HowLaser Hair Removal Works:
During the laser hair removal procedure, the laser device emits a controlled pulse of light that is absorbed by the pigment (melanin) present
in the hair follicles. The light energy is then converted into heat, which damages the hair follicles, inhibiting their ability to regrow hair in
the future. This process selectively targets the hair follicles without causing harm to the surrounding skin, making it a safe and precise
method of hair reduction.
Benefits and Outcomes:
Long-term Hair Reduction: The procedure can lead to a significant reduction in hair growth, resulting in smoother skin that requires
less frequent hair removal.
Precision: Laser technology allows for targeted treatment, minimizing damage to the surrounding skin while effectively treating the
hair follicles.
Speed: Laser hair removal can cover relatively large treatment areas in a short amount of time, making it an efficient option for hair
reduction.
Improved Skin Texture: After multiple sessions, clients may experience a smoother and more even skin texture in the treated areas.
Numberof Sessions and Individual Response:
Whatto Expect After the Procedure:
After the laser hair removal procedure, clients may experience the following:
Recommended Topical Products:
The number of laser hair removal sessions required varies depending on individual factors, including hair color, skin type, and hair growth
cycle. Most clients will need multiple sessions to achieve the desired hair reduction results. Typically, four to six sessions are recommended,
spaced several weeks apart, to target hairs in different growth phases.
Redness: Mild to moderate redness in the treated area is common and typically subsides within a few hours to a day.
Sensitivity: The treated skin may feel tender and sensitive for a short period. This sensation will diminish over time.
Hair Shedding: Over the following days to weeks, treated hairs may gradually shed from the skin. This is a normal part of the process.
Temporary Changes in Pigmentation: Some clients may notice temporary changes in skin pigmentation, such as darkening or
lightening of the skin. These changes usually resolve within a few weeks.
Minimal Swelling: Mild swelling in the treated area may occur but should subside within a day or two.
The practitioner may recommend specific topical products to use after the procedure. These products are typically chosen for their ability
to soothe the skin, reduce redness, and promote healing. Commonly recommended products may include:

  • Aloe vera gel
  • Calendula cream
  • Hydrocortisone cream (use as directed by the practitioner)
B E YOND BEAUTY MEDICAL AESTHETICs
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