Laser Hair Removal Consent Form

Name*

First NameLast Name

Date*

Gender*

Date of Birth*

Age*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Emergency Contact*

Name

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

How did you hear about us?*

YesNo

If yes, where, when and what body parts?

Where, when and what body parts

YesNo

Do you have any skin disorders?*

list any skin disorders

Do you have active cold sores or herpes simplex?*

Yes or no, if yes explain.

YesNo

If yes, list all:

if you are taking none, leave this field blank.

YesNo

If yes, please specify:

if you are taking none, leave this field blank.

YesNo

What is your skin type on the Fitzpatrick scale? (Use whether or jot your skin burns or tans in the sun for primary guidance)*

YesNo

Color of Hair in the treatment area:*

FineMediumCoarse

When was the last session of your regular hair removal?*

enter estimated time of last hair removal session aside from shave prep for session if receiving treatment today

YesNo

Brief Information

Laser hair removal involves the use of a non-invasive laser device for the reduction of facial or body hair. This works on the hairs that are in the active stage of growth and thus, it does not work on dormant hairs. The procedure for this requires more than one session. Please take note as well that the hair removal session may vary per individual depending on the amount of hair, density, or color. However, on average, we recommend around 6-14 sessions. Laser hair removal is not completely permanent and revisits may be needed for maintenance.

Preparatory Care Procedures

Prior to undergoing treatment, one must avoid over-exposure to sunlight or using tanning treatments for at least 2-3 weeks.

Shaving Requirement

All clients must be clean-shaven in all areas to be treated at least 24 hours before their laser hair removal appointment.

We do not shave clients. If you are not shaved, you will need to reschedule your appointment.

By signing, you understand and agree to this policy.

Please do not wax, tweeze, or use hair-removing creams in between treatments. Doing so can greatly decrease the efficacy of laser hair removal treatments.

It is recommended to be honest about recent sun exposure, medical history, and medications, as false information can increase the risk of adverse reactions, such as burns, hyperpigmentation, or ineffective results.

Potential Risks and Expectations

The following are possible risks that patients may experience with the hair removal treatment:

Disclose Medications. Inform your technician of any medications you are taking, especially photosensitizing drugs (e.g., certain antibiotics, acne treatments, GLP).

Avoid certain products. Discontinue the use of retinoids, glycolic acid, salicylic acid, and other exfoliating products on the treatment area 5-7 days prior.

No Makeup, Lotion, or Deodorant. On the day of your appointment, ensure the area is clean and free of any makeup, lotion, creams, or deodorant.

Minor wounds. Laser hair removal treatment can result in blistering, flaking of the skin, or sometimes swelling on the surface of the treated skin areas. In such cases, it is recommended that the area should heal first prior to undergoing another treatment.

Discomfort. Patients may experience discomfort during the treatment. Please take note that this is a normal occurrence.

Pigment changes. There is the possibility that there might be a darkening or lightening of the color of the skin during the healing process. This is usually temporary but on rare occasions, it can be permanent.

Eye exposure. Exposure to the eye with lasers can lead to temporary or permanent eye damage. However, please take note that we will provide eye protection during the treatment period. Please keep the protection on during the treatment and do not remove it unless allowed by us.

Scar. Scarring might occur in rare instances, especially if the prior or post procedures are not complied with. Thus, it is important that the pre and post-procedural treatment guidelines are carefully followed.

Be Honest About Skin Changes. Notify your technician of any changes in your skin, such as rashes, infections, or recent sunburns.

Post Care Instructions

Avoid Sun Exposure: Stay out of direct sunlight and avoid tanning (including tanning beds) for at least 2 weeks post-treatment. Use a broad-spectrum SPF 30+ daily.

Cool the Area if Needed. Mild redness, swelling, or warmth is normal. Apply a cool compress or aloe vera gel to soothe the skin as needed.

Avoid Heat & Sweating. For 24–48 hours, avoid hot showers, saunas, steam rooms, vigorous exercise, or anything that causes excessive sweating.

No Harsh Products. Avoid exfoliants, retinoids, or active skincare products (e.g., glycolic/salicylic acid) on the treated area for 3–5 days.

Do Not Pick or Scratch. If you experience itching or flaking, resist the urge to scratch or pick at the area to prevent scarring or pigmentation.

Avoid Hair Removal Methods. Do not wax, tweeze, or use depilatory creams between treatments. Shaving is the only approved method if needed.

Let the Hair Shed Naturally. Hair will appear to "regrow" but the hair that is Anagen phase will begin shedding. This is normal and may take 2–4 weeks depending on the speed of your hair growth.

Stay Hydrated & Moisturized.Drink plenty of water and keep the skin moisturized with a gentle, fragrance-free lotion.

Follow Up Treatments. Attend your follow-up sessions as recommended to achieve the best results.

I understand that the provider does not offer shaving services. I am responsible for proper pre-treatment hair removal prior to my appointment. I acknowledge that appointment time will not be allocated for shaving and that insufficient preparation may result in delayed, modified, or forfeited treatment.

I understand and agree that all services, packages, deposits, and treatment plans at Luxe Laser & Aesthetics are non-refundable. Once a treatment has begun, including preparation or equipment activation, no refunds will be issued, even if the session is shortened or discontinued. Prepaid packages are non-transferable, unused sessions have no cash value, and deposits are forfeited for late cancellations, no shows, or late arrivals. Luxe Laser & Aesthetics does not guarantee specific out outcomes and dissatisfaction or failure to follow pre- or post-treatment instructions does not constitute grounds for a refund. Store credit may be offered at the provider’s sole discretion for documented medical discontinuation.

I hereby authorize Luxe Laser & Aesthetics Inc. to perform laser hair removal on me. I understand the risks involved in the procedure and I understand that I may need to undergo several treatments in order to obtain my desired results. I understand the pre and post-treatment procedures needed for me to comply with upon undergoing the laser hair removal treatment. I have asked questions which are unclear to me and I have received explanation about them to my satisfaction.

I declare that I am of legal age and can exercise this consent with full discretion and responsibility to being legally bound under the terms and conditions of the treatment. By signing below, I release Luxe Laser & Aesthetics Inc, its medical staff, providers, and employees, including the supervising Medical Director, from any and all liability associated with this procedure.

Signature*

Date Signed*

Date

Personal Information

Medical History

Medications & Treatments