Your informed Consent

I hearby Authorise Sineal Cotsworth at Skinfluence Surrey to treat me using the AW3 Schnelle Diode Laser System.

I understand that the reduction/removal may not be 100%. I also understand that the treatment using the AW3 System may need to be performed in repeated sessions in future to maintain optimal results. 

I have been informed about alternative treatment possibilities and I understand that other forms of treatment - or no treatment at all - are choices that I freely have.

I understand that there are certain risks associated with the treatment and that these include, but are not limited to the following:

* Post-Treatment discomfort such as localised swelling, redness & mild tenderness of the area 
* Although uncommon, the treatment may cause blisters or light burns to the surface of the skin as a result of Light/Laser Treatment

* Transient Hypo or Hyper Pigmentation may occur and will usually fade within 3-6 months

* Crust formation or 'dirty skin' look is commonly seen for up to 10 days after Light/Laser treatment

*Scabbing, Swelling and/or Bleeding can occur as a result of Light/Laser Treatment - but these are temporary effects 

 

THE BELOW IS THE TREATMENT THAT WILL APPLY TO ME WHEN ACCEPTING THIS CONSENT

Hair Removal: Laser treatment is a method of treating unwanted hair. Unwanted hair may be caused by Medical Conditions such as Hirsuitism, Hypertrichosis, PCOS or Other Disorders. Treatments using the AW3 system will not cure any medical conditions that cause unwanted hair. 

The purpose of treatment is solely to achieve cosmetic improvements by reducing hair growth using a laser to destroy hair follicles

 

Accepting Terms & Consent*

I agree to follow the post treatment recommendations advised by Sineal Cotsworth/Skinfluence Surrey in order to ensure the best possible results.

I have been honest about my Medical History and have declared any medical conditions which apply to me. I understand it is my responsibility to inform Skinfluence Surrey of any changes to my medical history before the commencement of any/all treatments.

For Light/Laser Treatments I understand that excessive heat should be avoided for 48 hours and that exposure to the sun (including sunbeds) must be avoided for 30 days before treatment and 30 days after treatment - Except where advised by my Specialist). A sunblock of SPF30+ must be used on any exposed skin areas, otherwise it might be possible that blotchy skin pigmentation, hyper or hypo pigmentation may occur. 

I agree to co-operate with the recommendations of Skinfluence Surrey or the personnel while I am under their care, realising that any lack of co-operation could result in less than optimum results. 

I agree to inform Sineal/Skinfluence Surrey immediately if any adverse effects occur.

I agree to Photographic documetated of the treated area prior to treatment and throughout my journey.

I certify that I have read this entire informed consent document and I agree to all of its provisions. I certify that I have had the opportunity to ask any questions and that these questions have been answered to my satisfaction. I fully understand the treatment conditions & procedure.

I agree to pay for the above mentioned services and understand that there will be no refunds for any performed services. This consent form and cost covers the above treatment/areas only. Additional treatments can be added to this consent form and will be charged for as per the clinic price list, including single shot treatments. 

I have been made aware of the risks and I accept these terms and conditions as part of my treatment. We accept no liability for any of the above side effects. By accepting this, I agree to the terms and conditions and in the event of any of the above, I or any of my representatives will not pursue Sineal/Skinfluence Surrey in any means of compensation.