Laser Hair Removal

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Do you have or have you had any of the following conditions? If yes, please select them:AcneHeart conditionSeborrheaImmune disordersHepatitisLupusAsthmaHerpesPacemakerArthritisHirsutismPhotosensitivityAutoimmune DiseaseHIV/AIDSPolycystic OvariesBlood disorderHypo/Hyper PigmentationPoor Blood CirculationsCancerHysterectomyVaricose VeinsBreathing Problems/ DiseaseInsomniaPsoriasisFever blistersIrregular PeriodsShinglesLiver/ Kidney DysfunctionKeloid ScarringSkin disease/ lesionDiabetesLow/ High Blood PressureThyroid ImbalanceEczema/RashesMenopauseVitiligoEpilepsyMetal bone pins/platesWarts

Please state Yes or No for the following questions:

Are you currently (or possibly may be) pregnant? *YesNoMany health care providers recommend avoiding laser hair removal during pregnancy because of the lack of information about the effect on the fetus.

Do you have any allergies or intolerances? *YesNo

If Yes, please specify: *

Are you currently under a doctor’s care? *YesNo

If Yes, please specify: *

Have you been treated/ taken medication for cancer within the last 6 months? *YesNo

If Yes, please specify: *

Do you have any implants? *YesNo

If Yes, please specify: *

Have you ever been treated with hormone medications? *YesNo

If Yes, please specify: *

Have you taken any anticoagulants (e.g. warfin) or antiplatelet drugs (e.g. aspirin) withinthe last 6 months? *YesNo

If Yes, please specify: *(incluya fechas de medicación/tratamientos)

Are you taking any oral contraceptives? *YesNo

If Yes, please specify: *

Are you prone to fever blisters/ herpes? *YesNo

If Yes, please specify: *

Have you ever experienced keloid scarring? *YesNo

If Yes, please specify: *

Have you taken any anthistamines in the past week? *YesNo

If Yes, please specify: *

Have you had any direct sun or sunbed exposure in the last 6 weeks? *YesNo

If Yes, please specify: *

Have you plucked, waxed, or threaded the area(s) to be treated in the last 6 weeks? *YesNo

If Yes, please specify: *

Have you ever had any cosmetic/plastic surgery? *YesNo

If Yes, please specify: *(incluya fechas de medicación/tratamientos)

Have you ever had a glycolic acid peel, chemical peel, microdermabrasion or laser resurfacing? *YesNo

If Yes, please specify: *(incluya fechas de medicación/tratamientos)

Have you ever had Botox or Collagen injections? *YesNo

If Yes, please specify: *(incluya la fecha de su tratamiento más reciente)

ANY ADDITIONAL NOTES/ COMMENTS:

Health History *

I agree that all of the above medical information is true and complete. I agree to the privacy policy and terms and conditions.

GENERAL INFORMATION

Laser hair reduction offers results that cannot be achieved with conventional shaving or waxing. The laser works by targeting the hair in the follicle, below the skin’s surface. The laser energy is transformed into heat which destroys the hair follicle leaving the surrounding skin unaffected. Facial areas, bikini, upper and lower legs, arms, chest, and black may be treated leaving the skin smooth, stubble free, and without the irritation of ingrown hairs. In an hour or less, most body areas can be hair free. While some areas of the body are more sensitive than others, most patients report little or no discomfort. Again, this is a no down time procedure.
Hair grows in cycles. A minimum of four to six treatments will be necessary as the process is not effective on hair during the early growth cycle. After each session you will see substantial visible hair reduction. Each laser hair removal treatment will result in hair growth reduction. Additionally, hair will grow progressively slower, lighter, and finer with each treatment. It takes more than one treatment to affect all the follicles growing in an area.
The number of sessions will vary for each individual. During the initial visit the laser light disables those follicles in the “active” phase of the growth cycle. Follicles in the “dormant” phase will not be affected. Since follicles cycle through “active” and “dormant” phases, additional sessions may be desired once the “dormant” follicles become “active”. Most people achieve satisfactory clearance after four to six treatments, but individual result may vary depending on medical and genetic factors.
Lighter colored hair may require more treatments than darker colored hair.
Since no procedure can guarantee permanent hair removal, most patients can expect a 60% to 70% reduction in hair growth.

Client Initials: *

Client legal name *

I hereby consent to and authorize BEAUTY ESTHETICS Electrologist Technician to perform laser hair removal on me. I understand that this procedure works on the growing hairs and not on dormant hairs. For this reason, complete destruction of all hair follicles from any one treatment is unlikely, and I understand that I will require several treatments to obtain a significant, long-term reduction of hair growth. I also understand that maintenance treatments are needed to keep the growth away and that some people may not experience complete hair loss even with multiple laser procedures.

Please initial to acknowledge that you have been informed of the following:

The potencial benefits of the proposed procedure. *

Possible alternative procedures. *

The probability of success *

Possible risks and complications involved with the proposed procedure and subsequend healing period, including, but not limited to infection, scarring, crusting, regrowth of hair, and/or blistering. *

Pre and post treatment instructions. *

Please initial to acknowledge that you are aware of the following possible
experiences/complications/risks with the laser treatment:

Discomfort: Some discomfort may be experienced during laser treatment. *

Wound Healing: Laser Surgery can result in swelling, blistering, crusting, or flaking of the treated areas, which may require one to three weeks to heal. Once the surface has healed, it may be pink or sensitive to the sun for an addicional two to for four weeks, or longer in some patients. *

Bruising/Swelling/Infection: With some lasers, bruising of the treated area may occur. Additionally, there may be some swelling noted. Finally, skin infection is a possibility, although rare, whenever a skin procedure is performed. *

Health History *

I am aware and authorize the treatment after I have been informed of everything mentioned in the form section. I agree to the privacy policy and terms and conditions.

Client Initials: *

PHOTOGRAPH AND VIDEO RELEASE FORM

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With your signature if you would like your photos used or not used in advertising. We also like to tag our clients in photos used on our Instagram profile! Please indicate if you’d like to allow this or not below.

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