Laser Genesis Informed Consent
The Laser Genesis is a gentle, non-ablative laser procedure to improve skin texture and firmness, targeting the papillary dermis. The purpose of the procedure is to promote vibrant and healthy looking skin by creating a thermal response in the dermis that stimulates new collagen. I understand that multiple procedures are required and it is possible the result will be minimal help. I understand that a warming sensation may be experienced during laser treatment. I understand that facial hair can be temporarily affected and that desirable facial hair will be avoided during treatment. I understand that there can occasionally be areas of prickling sensation, but that overall, the treatment is comfortable.
I understand that the risks of this procedure include possible scarring, infection, bruising, hypopigmentation (lightening of the skin), hyperpigmentation (darkening of the skin), or unforeseen complications. I understand that I may experience some redness and mild swelling after treatment. I am not pregnant or trying to become pregnant, nor am I nursing at this time. In addition, there is a risk of eye injury if the laser beam accidentally strikes the eye. I understand that protective laser eyewear will be provided to me and that I will be responsible for wearing the eyewear throughout the entire treatment session in order to prevent eye injury from the laser beam.
My questions regarding this procedure have been answered satisfactorily. I understand the procedure and accept the risks, and request that this procedure be performed. I am also aware that Laser Genesis treatment is a procedure that is considered cosmetic and that I am responsible for all costs associated with the procedure. The results of Laser Genesis Treatments are usually very noticeable, although each client responds differently and no guarantees can be or have been made concerning expected results. No refunds will be given for treatments received.
I release Chrysalis Spa, Dr. Juan Stern, Alison Zollars, and all other staff, from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed and shall be binding upon my signature.