I,  Name , authorize and consent to the treatment of Hair reduction/modification with the Spectrum 810nm Diode laser System manufactured by Rohrer Aesthetics, Inc.

I have been advised by, Tania Honeycutt of the Arctic Medical Center & Spa, of the purported advantages and disadvantages associated with this treatment.

I understand that treatment with this laser system varies from patient to patient and that that more that 1-treatment may be required. initials 

Although rare, adverse outcomes such as hyperpigmentation and/or hypopigmentation (darkening or lightening of the skin), skin texture changes, and trace scarring can occur. initials   

No guarantees have been made to me regarding the outcome of the treatment or any improvements in my condition due to the procedure.  initials 

I understand that the possible benefits are the reduction and possibly the elimination of unwanted body hair.

Due to the brilliance of the laser light energy used, I agree to wear eye protection to shield my eyes.

I have been given the opportunity to ask questions and have received satisfactory answers to those questions.   initials   

I hereby authorize the taking of photographs. initials 

I hereby indemnify and hold harmless Rohrer Aesthetics, Inc. and their employees, the treating technician, and the staff at the office of Arctic Medical Center and Spa from any and all liability, damages, cost and expenses arising from or out of the use of the Spectrum 810nm Diode laser for treatment of hair reduction/modification.   initials

With all of the above information understood, I am choosing to be treated with the Spectrum 810nm Diode laser System.