• Laser tattoo removal

    Pre consultation information
  • IMPORTANT:

    BOOK A LASER TEST PATCH APPOINTMENT IMMEDIATELY AFTER COMPLETING THIS FORM. 

  • Format: (000) 000-0000.
  • Before we begin our journey of laser, there are some medical conditions that disqualify you from having this procedure. If you have any of the following conditions, you are not eligible for the treatment without a medical note from your healthcare provider. Even with a medical note, I am still able to decline you as a client for this procedure due to the risks involved. 

  • Conditions that would mean you were not able to have this treatments:

     
    Conditions affecting your Immune System


    -Previous Tattoo Removal Allergic Reaction

    -Systemic Lupus Erythematosus (SLE) an autoimmune disease often referred to simply as “Lupus”.

    -Severe Rheumatoid Arthritis especially if treated with “Gold Injections” or Methotrexate

    -Any other known auto-immune disorder

    -Any other disease affecting your immune function e.g. following removal of your Spleen

    -Liver disease such as Hepatitis A, B, C

    -HIV

     Bleeding Abnormalities

     -Haemophilia, Von Willibrands Disease, Thrombocytopenia

     Blood Thinning Medication

     -Anticoagulants such as Warfarin, Heparin, Clexane Or Dabigatron

     -High doses of Aspirin, Ibuprofen, Diclofenac (NB Prophylactic slow release Aspirin at 75 mg day or less is acceptable)

     Skin Conditions

     -Prone to Keloid or very thick scarring

     -Vitiligo or any other skin pigmentation problem

     -Psoriasis or eczema (on treatment area)

     Cancer treatment

     -Photodynamic Therapy (PDT) for Cancer

     -Chemotherapy/Radiotherapy for Cancer, Leukaemia, Myeloma or Lymphoma

     Other Conditions Where Fragmented Ink Particles Could Cause Harm

     -Currently Pregnant

     -Breast Feeding

     -Acute or Chronic Kidney Disease

     -Type 1 Diabetes & type 2 when on medication

     -Implants / Metal Plates/ or Pacemakers

     Conditions that need a doctor’s letter to confirm the treatment is suitable before treatments can begin:

     -Epilepsy

     -Transplant Anti-Rejection Drugs

     -Thyroid Disease

     -Heart Disease

     -Hypertension (High blood pressure treated with medication)

     -Cancer - after 12 months

     The list below is of things that require a waiting period until you can start treatments:

     - Active Herpes simplex (Cold Sores) - wait 2 weeks until its healed and use antiviral medication a few days before and continue a week after treatment

     -Acute fungal infections - Wait until the condition has cleared until having your treatment

     -UV exposure from sunbathing or sunbeds - wait 4 weeks before your starting your treatment and please note you cannot sunbath or go on a sunbed during your course of treatment

     -Chemical Peel, Microdermabrasion or Radio Frequency - wait 4 weeks before starting treatments and do not have in the area during your treatment course.

     -Medical Chemical Peels, Dermabrasion, Laser Skin Resurfacing or Face Lift at site of treatment - wait 6 months before starting treatments and do not have in the area during your treatment course.

     Drugs & Herbal Remedies

     -Fever Few or St John’s Wort - both of these herbs are photosensitising

     It is recommend that the client stops taking the preparation and waits 4 weeks for the herb to be completely cleared from their system before treatment - otherwise client skin may be burned.

     Over the counter pain relief e.g. non-steroidal

     -Antiinflammatory/pain relief drugs such as Ibuprofen and/or Aspirin these must be allowed to clear from a client’s system before any treatment – suggest a delay of one – two weeks before treatment begins.

    Prescribed a drug for a short term (course of less than six weeks) by their GP/Hospital

     -The course should be finished and wait at least a further six weeks for any drug to be completely excreted from their system before having treatment. (Notable drugs that can cause problems during laser and or IPL use are Tetracycline antibiotics and steroids)

     -Prescribed a long term drug (a course lasting longer than 6 weeks) by their GP/Hospital

     Please refer back to the prescribing doctor for a letter of authorisation for the treatment to go ahead. Notable long term drugs that can cause problems are Ro-Acutane used in Acne treatments (specifically listed on Medical History form), Minocin which is an antibiotic (frequently used in long term Acne therapy) and Amioderone a drug used in Cardiology.

  • Do you have any of the above listed medical conditions?
  • If the answer was yes please understand you must get a medical note from your primary doctor. It is ultimately my choice weather we move forward. Please fill in the rest of the form if you answered no. And also if you answerd yes and think you may still be approved by your healthcare provider

  • Have you had laser removal in the past?*
  • (Skip of no^)If yes, was it successful?
  • We will sit down together and go over everything involved in this process. From how it works to how it feels and as well as possible reactions. We will discuss pricing and options for packages based off of the ink we are looking to remove. Brows, lips and body art all have different procedures for removal. I will make sure your fully understanding of the process before moving forward. 

  • Body (NOT BROWS) tattoo removal

    Different section for Brow and PMU removal (skip to next page)
  • Is there any color?
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  •  Brows on next page 

  • Brows/Lip PMU removal

    If you are getting body art removed please skip this page
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Do you plan on getting them redone after the removal?
  • For new clients coming for removal, I will be offering special rate packages that includes undo/redo of the brows. Would you be interested in going over options at your in person consultation?
  • After you finish this form, please book an in person laser consultation where I will perform a patch test. 

  • Unrealistic Expectations: Clients with unrealistic expectations about the outcomes of the procedure may not be suitable for treatment. Do you understand that all outcomes are not predictable, that you will enter these treatments with realistic expectations?*
  • -Mental Health Conditions: Certain mental health conditions, particularly those affecting judgment or perception of reality, may complicate treatment decisions. Do you acknowledge that you do not suffer from any decision making or judgment impairing mental health conditions or personality disorders?*
  • - Non-compliance with Aftercare: Clients who are unlikely to follow post-treatment care instructions may not be suitable candidates. Do you agree that you will follow the aftercare instructions provided? Do you understand that you are solely responsible for any infections or adverse effects resulting from not following the given aftercare instructions?*
  • -Recent Tattoos: Tattoos that are too fresh may not be treatable until they have properly healed, typically at least 6-8 weeks. Do you agree that the tattoo you want removed is not newer than 8 weeks?*
  • Feel free to book your laser test patch appointment immediately after filling out this form.

    If we are going to move forward with th procedure, I will be performing a single spot test. We can book our first session as soon as 1 week after the spot test if there are zero adverse affects. The actual healing time in between sessions is 6-8 weeks for a full session of removal.

    I will go over all pricing options as well as packages with you at the Iin person consultation.

    in person consultation will take 15-30 mins approximately.  

    So excited to start this journey with you!

  • Should be Empty: