Laser Hair Removal Consent & Information Form

I hereby authorize Dolce Medical Spa, Organic Salon & Salt Room to perform laser assisted 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 not possible and I understand that I will require several treatments to obtain a significant, long-term reduction of hair growth. I also understand that some people may not experience complete hair loss even with multiple laser treatments.

The following points have been discussed with me and I have had the opportunity to ask questions:
• The potential benefits of the proposed procedure
• The possible alternative to this procedure
• The probability of success
• The reasonably anticipated consequences if the procedure is not performed
• The most likely possible complications/risks involved with the proposed procedure and subsequent healing period, including, but not limited to infection, scarring, crusting, re­growth of hair, or blistering
• Pre and post treatment instructions

I am aware of the following possible experiences/risks that can happen.

DISCOMFORT: Some discomfort may be experienced during laser treatment.

BRUISING/SWELLING/INFECTION: Occasionally, bruising of the treated area may occur. Additionally there may be some swelling, or rarely an infection of the skin at site of the treated area may occur.

SKIN PIGMENT CHANGES: During the healing process, there is a slight possibility that the treated area can become either lighter or  darker in color compared to the surrounding skin. This is usually temporary but rarely may be permanent.

WOUND HEALING: Laser Hair Treatment can result in swelling, blistering, crusting or flaking of the treated areas, which may require  1-3 weeks to heal. Once the surface has healed, it may be pink  or sensitive to the sun for several months or longer in some patients.  This is more likely to happen in patients taking medications causing  photosensitivity or in patients with dark skin.

SCARRING: Scarring is a rare occurrence, but it is a possibility when the skin's surface is disrupted. To minimize the risk of scaring, it is important to follow all post-treatment instructions carefully.

EYE EXPOSURE: Protective eyewear (colored shields) will be provided for wear during the laser treatment. It is MANDATORY that the shields be worn at all times during the treatment. Failure to do so could result in accidental laser exposure to the eye that could cause vision damage.

LACK OF PERMANENT RESULTS: Treatments may vary among patients. For some this may mean a significant decrease in the frequency with which you must shave or tweeze. For others it may mean  permanent cosmetic improvement because hair re-growth is minimal, very fine or completely absent. EVERYONE WILL EXPERIENCE SOME HAIR RE-GROWTH over time; regardless, hair that grows back will tend to be finer, lighter and less dense.

PRE / POST INFORMATION:

For your safety and in order to obtain optimum results, the instructions below must be followed.

Do not wax, tweeze, color, use depilatory creams or have electrolysis on the treatment area for at least 4 weeks before and throughout the entire course of your treatments. Shaving and clipping is permitted as often as desired.

Shave the treatment area the morning of your scheduled treatment, unless instructed otherwise. If you cannot shave the area we will shave the area for an additional $25 charge.

Avoid wearing lotions or deodorant if underarm is being treated.

Do not use any of the following products on the treated area 3 days before or 3 days after treatment: harsh exfoliating cleansers or scrubs, bleaching creams or retinoids (Retin-A).

Avoid direct prolonged sun exposure 2 weeks before and 2 weeks after treatment on the treated area.

Apply a sunscreen of at least 30 SPF or higher every 2 hours to prevent post-procedure side effects if exposed to the sun.

After treatment the area may feel like a mild sunburn; a cool compress or aloe can be applied.

Please adhere to the appropriate treatment intervals recommended by your provider, as the hair growth cycle determines the efficiency and number of treatments required.

Cleanse the area with tepid warm water. Avoid extremities of heat such as hot showers, hot tubs, and saunas for 72 hours after treatment.

The hairs that are eliminated from the treated area will gradually work themselves out; this can take 3-4 weeks. Do not pick or scratch the treated areas.

If you are experiencing in-grown hairs, a gentle exfoliator may be used in between treatments.

Although extremely rare a blister may appear. Please contact the office and we will further instruct you.

There is no guarantee that laser hair removal will be completely effective on every individual.

Please inform the staff of all medications you are taking; some medications can make you photosensitive.

Please notify your provider of any metal plates, screws or rods in the treatment area.

Please notify your provider if you have a history of cold sores in the treatment area.

You are not a candidate if you are pregnant, breastfeeding, or on oral antibiotics. 

If you must cancel your appointment, please give us at least 24-hour notice to avoid any late cancellation fees.

By typing my name below, I certify that I have read and fully understand the contents of this permit for laser hair removal and that the disclosures referred to herein were made to me.