LASER HAIR REMOVAL WAIVER AND INFORMED CONSENT FORM

Treatment Description

Laser hair removal uses pulses of laser light to target and destroy hair follicles. Multiple treatments may be necessary for optimal results. Results may vary based on individual skin and hair type.

Risks and Possible Side Effects

I understand that the following risks and side effects may occur, including but not limited to:

• Discomfort or mild pain

• Temporary redness, swelling, or irritation

• Hyperpigmentation or hypopigmentation

• Blistering or scabbing

• Burns or scarring (rare)

• Infection (rare)

I understand that sun exposure, tanning, certain medications, or skin conditions may increase risks.

Contraindications

I confirm that:

• I am not pregnant or breastfeeding.

• I do not have a history of keloid scarring.

• I have disclosed any history of skin conditions (e.g., eczema, psoriasis).

• I am not currently taking medications such as Accutane or photosensitizing drugs.

• I have not used tanning beds or had sun exposure on the treatment area within the last 2 weeks.

Absolute Contraindications (Generally Exclude Treatment)

1. Pregnancy or Breastfeeding

   • Due to lack of research on safety during pregnancy; hormonal changes can also affect results.

2. Active Cancer or History of Skin Cancer (especially melanoma)

   • Risk of stimulating skin changes or complications in areas of concern.

3. Use of Photosensitizing Medications

   • Examples: Accutane (isotretinoin), antibiotics like tetracycline, or certain antidepressants.

   • Increases risk of burns or pigmentation issues.

4. Epilepsy (especially photosensitive epilepsy)

   • Flashing lights may trigger seizures.

5. Open Wounds, Active Infections, or Cold Sores in Treatment Area

   • Increases risk of spreading infection or poor healing.

6. Keloid Scarring or Poor Wound Healing

   • Risk of abnormal scar formation.

Relative Contraindications (Need Medical Clearance or Caution)

1. Diabetes (especially if uncontrolled)

   • May impair healing or increase risk of infection.

2. Polycystic Ovary Syndrome (PCOS)

   • Laser can help with hair, but underlying hormonal imbalance may limit long-term effectiveness.

3. Autoimmune Diseases (e.g., lupus, vitiligo, scleroderma)

   • May cause skin to react unpredictably or heal poorly.

4. Skin Disorders (e.g., eczema, psoriasis, dermatitis)

   • Especially if active in the treatment area.

5. Recent Chemical Peels, Microdermabrasion, or Sunburn

   • Skin must be healed before treatment.

6. Tattoos or Permanent Makeup in Treatment Area

   • Laser can damage ink and cause burns or color changes.

Additional Considerations

• Tanned Skin (natural or artificial): Increases risk of burns or hyperpigmentation.

• Use of Retinoids or AHA/BHA Products: Can thin the skin, increasing sensitivity.

• Dark skin types (Fitzpatrick IV–VI): Can be treated safely with the right laser (e.g., Nd:YAG), but requires extra care to avoid pigment changes.

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Client Responsibilities

I agree to:

• Follow all pre- and post-treatment instructions.

• Inform my technician of any changes to my medical history or medications.

• Refrain from waxing, plucking, or using depilatory creams before or during treatment series.

Consent and Acknowledgment

I acknowledge that:

• No guarantees have been made regarding results.

• I have had the opportunity to ask questions and all questions have been answered to my satisfaction.

• I am fully aware of the risks, benefits, and alternatives to this treatment.

I voluntarily request and consent to laser hair removal treatment. I release the technician, facility, and any affiliated personnel from liability associated with this procedure, to the extent permitted by law.