• Summer Rose Electrolysis — Client Intake, Treatment Overview & Consent, Cancellation Policy

  • Format: (000) 000-0000.
  • Select NONE or Check what applies to you:
  • Select NONE or Check what applies to you:*
  • Have you had electrolysis before?*
  • Skin Condition & Sensitivity that apply to you or select NONE:*

  • Skin Type

  • Select your skin type:

  • Clients with sensitivities may be at higher risk for redness, swelling, scabbing, or scarring during electrolysis. Your electrologist may recommend modified treatment techniques to minimize risk. Full healing and results may vary based on individual skin sensitivity.

  • Mole Treatment Policy & Consent

    For safety, electrolysis CANNOT be performed on moles, raised skin lesions, or suspicious skin markings without clearance from a licensed medical professional.
  • Do you have mole(s) you want treated?
  • I have a doctor’s note authorizing treatment of the mole(s)?
  • Would you like to talk more about your options to treat your mole(s)? If you don’t have a doctors note don’t worry let’s talk first.

  • Treatment Area(s) & Hair Preparation

  • Hair Preparation Questions:

  • Important Guidelines: Hair must be grown out enough to be treated —Do not shave 3–4 days prior to treatment. Do not tweeze/wax 7–10 days prior to treatment.

     I need enough length where my tweezers can grab the hair. For example if you can get your hair under your finger nail its probably enough for me to grab. -Summer

     

  • End of Client Intake & Health History

  • Electrolysis Treatment Overview & Acknowledgement

    Electrolysis is the only FDA-approved method for permanent hair removal. A fine, sterile probe delivers a precise electrical current to destroy hair growth cells without harming the skin. Treatment is personalized; multiple sessions required (potentially 12–24 months for full results depending on the area. For example the face is the most hormonal area and can take the longest for results while the arm could take up to 5 treatments total due to less hormonal. Results are dependent on hormones, hair thickness, density, and how often the client maintains coming). Side effects are usually mild and temporary: redness, swelling, scabbing, warmth, irritation, rare scarring/discoloration. Proper aftercare is essential.

  • Electrolysis is a method of permanent hair removal that uses electrical current to destroy the growth cells of the hair follicle.
    Multiple sessions are required.
    Temporary redness, swelling, white pustules, or pinpoint scabbing may occur.
    Rare but possible risks include: infection, hyperpigmentation, hypopigmentation, and scarring.
    Aftercare Instructions
    Keep treated area clean and avoid touching.
    Do not tweeze or wax between sessions.
    Avoid tanning, makeup, saunas, direct sun, or excessive sweating for 24–48 hours.
    Apply soothing products as recommended (witch hazel, aloe vera).

  • End of Treatment Overview & Consent to Treat

  • Cancellation Policy

    • Appointments: Please arrive on time. Late arrivals may shorten your session.
    • Cancellation/Reschedule Within 24 Hours: Appointments canceled with less than 24 hours’ notice will be charged 50% of the scheduled service.
    • Failed Appointment (no call/no attendance): Will be charged 75% of the scheduled service. 

    Late Payment Policy

    • Unpaid balances may cancel or prevent future appointments

    Confirmation & Reminder Texts

    •  Confirmation text is seent immediately when your appointment is sceduled, please contact me asap if you do not recieve one because this means your appointment has not been booked.)
    • 24-hour reminder text sent day before appointment
    • Clients responsible for verifying date/time on text reminders; discrepancies must be reported 24 hours prior
    • Text the appointment reminder text to reach me fast or via business number

    Late Arrivals & Accessibility

    • Arrive on time; late arrivals will have remaining time used for treatment
    • No reduction in cost or extension of treatment time
    • Extra time for mobility/accessibility is included within the session

     
    Appointment Time Modifications

    •  Except first consultations, appointment times cannot be changed upon arrival without 24-hour notice
    • Use booking website for availability and reschedules; do not request cancellations/reschedules via message


    Frequent Reschedules or Cancellations
    Clients who frequently reschedule may be scheduled farther out to ensure availability

     
    Payments & Pricing

    • Payment is due at time of treatment
    • Accepted forms: Cash, Check, Venmo, Apple Pay, Debit/Credit
    • Pricing Disclaimer: Please be aware that service prices may fluctuate over time due to changes in business or supply costs. Clients will receive notice of any updates.

     
    Communication Policy

    •  Phone calls are not answered during sessions
    • Voicemail or text messages will be returned within 24 hours
    • Best way to contact me is by texting the automated notification text message you recieved when you made your appointment or when it gave the 24 hr notice. Another way is when you go to book click "Contact Us." The reason being is because it goes to all my devices.

     

  • End of Cancellation Policy

  • Client Consent & Acknowledgment

  • By signing below, I understand and agree to the following disclosed in the Client Intake, Treatment Overview, Consent to Treat & Cancellation Policy:
    ✔️Electrolysis is a form of permanent hair removal but requires multiple sessions.
    ✔️Temporary side effects may include redness, swelling, pinpoint scabbing, or tenderness.
    ✔️Rare risks may include pigmentation changes or scarring.
    ✔️Results vary depending on consistency, skin type, and health factors.
    ✔️I have disclosed all relevant and accurate health and medical information truthfully.
    ✔️I release Summer Rose Electrolysis from liability for any undisclosed conditions that may affect treatment.

    ✔️I agree and will abide to the Cancellation Policy

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