• Laser Tattoo Removal

    Consent, contract and liability waiver
  • Format: (000) 000-0000.
  • Today’s date*
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  • Medical History

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  • Are you currently using any of the following?*
  • Here's is a more Indepth list of medications that cause photosensitivity.  If you are currently taking any lister or have in the last 6 months, please selet other above if you don't see the exact option and fill in the box below with the specific medication(s)

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  • DO NOT SKIP. MUST READ!


    Laser treatments can pose significant risks for individuals with specific health conditions or symptoms. If you experience any of the following you should approach laser treatments with caution. 

     

    Risk Factors for Laser Treatments


    - Hormonal imbalances  

    - Polycystic ovary syndrome  

    - Thyroid problems  

    - Depression  

    - Anxiety  

    - Herpes  

    - Regular smoking  

    - Psoriasis  

    - Eczema  

    - High blood pressure  

    - Allergies  


     If you have any of the following you are particularly at risk and are generally advised against laser removal procedures. Always consult a healthcare professional prior to undergoing any laser treatment to assess the associated risks based on your medical history.


    Conditions That Directly Affect Safety

     
    - Skin pigmentation problems  

    - Melasma  

    - Vitiligo  

    - Suntanned skin  

    - Keloid formation scars  

    - Pregnancy  

    - Epilepsy  

    - Photosensitizing conditions (e.g., lupus)  

    - Communicable diseases (e.g., HIV)  

    - Immune system disorders  

    - Poorly controlled diabetes  

    - Cancer  

    - Radiation therapy  

    - Chemotherapy 

  • Aftercare Instructions

  • Aftercare Instructions for Laser Tattoo or PMU Removal

     
    1. Keep the Area Clean:

       - Gently cleanse the treated area with mild soap and water.

       - Avoid scrubbing or harsh chemicals.


    2. Apply Ice or Cold Packs:

       - Use ice packs wrapped in a cloth for 10-15 minutes to reduce swelling and discomfort.  


    3. Moisturize the Area:

       - Apply a thin layer of healing ointment recommended by your practitioner (e.g., Aquaphor) to keep the area moisturized.


    4. Avoid Sun Exposure:

       - Protect the treated area from sunlight using sunscreen with a high SPF or by covering it with clothing for at least 4-6 weeks.

     
    5. Do Not Pick or Scratch:

       - Avoid picking, scratching, or peeling the treated area to prevent scarring and infections.

     
    6. Avoid Heat and Sweat:

       - Steer clear of hot baths, saunas, swimming pools, and intense workouts for at least 48 hours after the procedure.

     
    7. Monitor for Side Effects:

       - Expect redness, swelling, and mild discomfort, which are normal reactions. You may also notice blistering or scabbing as the skin heals.

  • Healing Process

  • After a laser tattoo removal procedure, common side effects may include:

     
    1. Redness: The treated area is often red immediately after treatment, similar to a sunburn.

     
    2. Swelling: Mild swelling around the tattoo site is typical and usually subsides within a few hours to a few days.

     
    3. Pain or Discomfort: Some individuals may experience a sensation similar to a rubber band snap during the procedure, with mild pain lingering afterward.


    4. Blistering: Small blisters may form as the skin heals, which is a normal response to the laser treatment.


    5. Scabbing: As blisters heal, they may turn into scabs, which should be left to fall off naturally to prevent scarring.

     
    6. Itching: The treated area may itch as it heals, which is a common part of the healing process.


    7. Changes in Skin Color: The skin may temporarily become lighter or darker in the treated area, particularly in individuals with darker skin tones.


    8. Flaking: As the skin heals, flaky skin may occur, similar to the healing process after a sunburn. 


    9. Infection: Though rare, there is a risk of infection at the treatment site, which should be monitored for any signs of pus or increasing redness.


    10. Temporary Hair Loss: Hair may fall out in the treated area, although this is generally temporary and may not occur for all individuals.

     
    These side effects are typically mild and resolve within a few days to a few weeks. However, if you experience significant discomfort or signs of infection, it's essential to contact your healthcare provider promptly.

     


    Possible Reactions to Monitor

     
    - Increased redness or swelling beyond the initial 72 hours  

    - Severe pain or discomfort not relieved by over-the-counter pain medication  

    - Signs of infection, such as pus or increasing warmth in the area  

    - Persistent blistering or unexpected skin changes  

    - Allergic reactions or any unusual symptoms  

     

     
    When to Seek Medical Attention

     
    - If you experience excessive swelling or redness that worsens after the first few days  

    - If you notice any signs of infection, such as fever, increased pus, or spreading redness  

    - If the pain becomes intolerable or is not manageable with prescribed medications  

    - If any rashes or hives develop in response to the treatment  

    - If you experience symptoms such as difficulty breathing or a rapid heartbeat, seek emergency care immediately.  

     


    Following these aftercare instructions can help promote healing and reduce the risk of complications after laser tattoo or PMU removal. Always consult with your practitioner for any personalized guidance or if you have any concerns.

  • Procedure & Photo Consent

  • In the industry of aestetics, photos of our work is what gets new clients to make their decision to get in the chair for themselves. As a small business, I rely on photos of my work to keep my buisness growing. It also helps future clients have a plethora of options to review when choosing styles or colors.  If you are confortable I greatly appreciate you allowing me to share photos and/or videos of my work. I'm requesting your consent to use such photos or videos to be used on either my instagram, websites, and promotional material. If you are not comfortable I completely understand. 

  • Are you comfortable with images or video of your procedure being used for social meadia and/or website, promotional material?*
  • If yes, would you like to be tagged?
  • Liability Waiver

  • -I understand that it is my responsibility to advise the technician of any concerns I may have before they begin the procedure.

    -I am not under the influence of any drugs or alcohol.

    -I am not pregnant.

    -I release the studio and its representatives and subsidiaries of all claims for injury, seen or unseen, that may occur as a result of this procedure.

    -No warranty has been made to me as a result of laser tattoo removal or correction procedure, and that the final result cannot be guaranteed.

    -There may be risk of infection if aftercare instructions are not followed.

    -I realize that there is potential for discomfort during the procedure and during the healing process.

    -There is a possibility of bleeding, swelling, and allergic reactions to the laser used.

    -A tattoo can only be removed with surgical, saline or laser procedures, and that any effective removal may leave permanent scarring or disfigurement.

    -My technician will not, under any circumstance, perform any procedures on me if I am known to have any allergies related to the products used.

    -I understand that I must inform my technician of any and all medication(s) I am currently taking. (Pain control medications such as aspirin or ibuprofen may cause the blood to thin, and excessive bleeding may occur during or after the procedure.) all listed in this form above

    -I do not currently take Accutane and/or have not taken for at least 12 months.

    -I agree to follow the provided aftercare instructions.

    -I certify that this Disclosure & Release Agreement was completed by me and that all entries and information are true and complete to the best of my knowledge.

    - I fully understand the questions, terms, and conditions of this Disclosure & Release Agreement. I accept to waive my rights for any claim against the technician for any reason whatsoever.

  • Date.*
     - -
  • Contract for Laser tattoo/PMU removal

  • Format: (000) 000-0000.
  • Provider Name: Brooke Marcucci

    Provider Business Name: Sugar & Ink (The Doll Factory)

    Provider Address: 1209 Troy-Schenectady road, Latham 12110 

    Phone Number: (518)-429-5387

    Email Address: Thedollfactory1143@gmail.com  

     


    1. Services    

    The Provider agrees to perform laser tattoo removal services on the Client's specified area. The tattoo removal process is understood to be a series of treatments that may vary in number based on the tattoo's size, color, and depth.


    2. Acknowledgment of Risks  

    The Client acknowledges that they have been informed of the following risks associated with laser tattoo removal:


    - Potential for skin injuries, including burns and blisters.

    - Possibility of scarring or changes in skin texture.

    - Incomplete removal of tattoo pigment or color.

    - Variability in results based on individual skin type, tattoo characteristics, and healing response.

     
    The Client understands that results are not guaranteed and that multiple sessions may be required.

     
    3. Consent to Treatment  

    The Client voluntarily consents to undergo laser tattoo removal and acknowledges that they have had the opportunity to ask questions regarding the procedure and its potential risks.

     
    4. Medical History Disclosure

    The Client agrees to disclose any relevant medical history, including skin conditions, allergies, medications, and other factors that may affect the treatment.

     
    5. Release of Liability  

    The Client hereby releases, waives, and discharges the Provider, its employees, and agents from any and all claims, demands, or causes of action that may arise from the tattoo removal procedure, including but not limited to, claims for personal injury, property damage, or wrongful death.

     
    6. Indemnification  

    The Client agrees to indemnify and hold harmless the Provider from any claims, damages, or expenses, including attorney's fees, arising out of the Client's participation in the tattoo removal process.

     
    7. Governing Law  

    This Agreement shall be governed by and construed in accordance with the laws of the State of New York.

     
    8. Entire Agreement  

    This Agreement constitutes the entire understanding between the parties and supersedes all prior agreements, whether oral or written, concerning the subject matter herein.


    IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written.

  • Date*
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  • Provider Information

    Please ask for me to come do this part and complete this portion
  • Date*
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  • Full Name: Brooke Marcucci

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