LASER TATTOO REMOVAL CONSENT

If client is a minor, stop here and use your state-specific minor consent and guardian authorization process.

I request and authorize laser tattoo removal using a picosecond laser device on the tattoo area(s) identified and photographed for my chart. I understand that laser energy targets tattoo pigment and that my body gradually clears fragmented ink over time. I understand that complete removal cannot be guaranteed. Results vary based on ink color, ink density, tattoo age, body location, skin tone, sun exposure, immune response, cover-up layering, and any scar tissue already present in or under the tattoo.

Common sources describing laser tattoo removal risks and expected reactions include NCBI StatPearls, ASDS, ASLMS, and FDA
consumer guidance.

Client must update this information before every session. Treatment should be postponed if anything here changes in a way that makes treatment unsafe. By checking these boxes I attest the following does NOT apply to me:

• Redness, swelling, warmth, tenderness, frosting, pinpoint bleeding, blistering, crusting, or itching can happen.
• Blisters are common and are not automatically a sign that something went wrong.
• The tattoo will usually lighten gradually over several weeks, not overnight.

By signing this consent form I confirm that I am removing all liability from Spark Project, Inc and its affiliates in accordance to this procedure as pursuant from the state of Arizona, USA. I acknoledge that I have fully read all above statements and understand my risks involved with the laser tattoo removal process done by a picosecond laser machine.