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  • La Ritz Spa & Salon IPL Treatment Informed Consent

    Medical History
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  • IPL Treatment Informed Consent

    Medical History Page 2
  • Flaking of pigmentated lesions - crust may take 5 to 10 days to disappear and it is important not to manipulate or pick which may otherwise lead to scarring Discomfort - During the procedure, I might experience a sensation similar to a rubber band snap which degree will vary per my skin condition and area sensitivity but that does not last long.  A mild "Sun-Burn" sensation may follow for typicalluy up to one hours and will be reduced with application of cooling and soothing creams. Reddening and swelling - severity and duration depend on the intensity of the treatment and the senisitiviy of the area to be treated.  The phenomena may be reduced with application of cooling and/or anti-inflammatory creams Brusing may rarely occur and may last up to 2 weeks. 
  • Natural or artificial sun exposure in the past 3-4 weeks pre-op or the following 3-4 week post-op plan Use of self–tanners or tan enhancer caps within the past 3-4 weeks pre-op plan Photosensitive herbal preparations (St John’s Wort, Ginkgo Biloba, etc) or aromatherapy (essential oils) Diseases which may be stimulated by light at 400 nm to 1200 nm, such as history of Systemic Lupus Erythematosus or Porphyria Pregnant or possibility of pregnancy, postpartum or nursing
  • IPL Treatment Informed Consent

    Medical History Page 3
  • IPL Treatment Informed Consent

    Medical History Page 4
  • My signature certifies that I have duly read and understood the content of this informed consent form, and gave the accurate information as to my health condition. I hereby freely consent to M22 IPL skin treatments
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