Laser Tattoo Removal Consent Form

Laser Tattoo Removal Consent Form
Client Name*

First NameLast Name
Date of Birth*

MonthDayYear
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Treatment Area
Date

MonthDayYear
Treatment Information

Laser tattoo removal works by delivering light energy into the skin to break down tattoo ink particles. These particles are gradually eliminated by the body’s lymphatic system over several weeks. Multiple treatments are required, and complete removal cannot be guaranteed.
I understand that:*

Multiple sessions are necessary (typically spaced 6–8 weeks apart)Results vary based on ink color, depth, skin type, tattoo age, and individual healingSome tattoos may fade but not completely disappear
Possible Side Effects & Risks

I understand that the following may occur:
Common and temporary*

Redness, swelling, tendernessWhitening (“frosting”) immediately after treatmentBlistering, scabbing, or crustingItching or dryness
Less common*

Hyperpigmentation (darkening)Hypopigmentation (lightening)BruisingInfectionScarring (rare)Incomplete ink removal or ink color changes (some colors are more resistant)
Pre & Post Care Responsibility

I understand that proper aftercare is essential for safe healing and best results.
I agree to:*

Avoid sun exposure and tanning before and after treatmentsFollow all pre- and post-treatment instructions providedKeep the area clean and avoid picking, scratching, or removing scabs/blistersUse SPF 30+ on exposed areas after healing
Failure to follow aftercare instructions may increase the risk of complications or poor results.
Medical Disclosure
Please check any that apply:

Pregnancy or breastfeedingDiabetesAutoimmune conditionHistory of keloid or hypertrophic scarringSkin infections, rashes, or open wounds in the treatment areaUse of Accutane in the past 6–12 monthsPhotosensitivity or use of light-sensitizing medicationsBlood thinners or bleeding disordersHistory of skin cancerOther medical conditions
Please specify other medical conditions if applicable:
Consent & Liability Release

I understand the nature of the procedure, expected results, and possible risks.
I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction.
I understand that:*

No guarantee of complete removal has been madeResults vary from person to personMultiple treatments will be requiredI may experience temporary or permanent skin changes
I consent to receive Laser Tattoo Removal treatments.I release the provider and business from liability for any complications resulting from failure to follow instructions or from undisclosed medical conditions.
Photography Consent
Your comfort and privacy are very important to us. The following permissions are completely optional and will not affect your treatment in any way. Please check only if you feel comfortable.

I consent to before-and-after photos for my treatment recordI consent to the use of my photos for educational or marketing purposes (identity will remain confidential)
Client Name:*
Client Signature*
Date*

MonthDayYear
Should be Empty:

Laser Tattoo Removal Consent Form

Treatment Information

Possible Side Effects & Risks

Pre & Post Care Responsibility

Medical Disclosure

Consent & Liability Release

Photography Consent