We are 100% committed to the health and well-being for everyone. We are doing everything we can to keep potential exposure out of our office.

As part of the local and state guidelines you must answer no to all the following questions each time you enter Pua Manu Medspa.

• Not present a fever over 100 F/ 37 C.
• Not presenting cold, cough, difficulty breathing muscle pain, headache,
• loss of taste/smell or pink eye in past 14 days.
• Not in contact with anyone with these symptoms in the past 14 days.
• Not currently under quarantine order or directive.
• Not in contact with anyone diagnosed with COVID-19, sick and quarantined, in the past 14 days.
• All information above is true. I may be asked again when I arrive for my appointment. 

ALL PATIENTS AND STAFF ARE REQUIRED TO: 

• Please follow our local and state regulations and guidelines, including those related to occupancy levels, social distancing and other measures intended to reduce the spread of viruses.
• Stay home if you are sick or are exhibiting symptoms of illness such as a fever or persistent cough.
• Face mask are required to enter the Spa.
• Refrain from shaking hands or other touching rituals.
  Wash hands for 60 seconds with soap and warm water prior to treatment or use hand sanitizer.
• Refrain from eating or drinking while in the Spa, face mask should not be removed. 

I agree to comply to the rules listed above.

 

I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact, and as a result, federal and state health agencies recommend social distancing. I understand that Pua Manu Medspa has put in place reasonable safety measures to help reduce the spread of COVID-19.

I understand that COVID-19 may cause additional risks, some of which may not be known at this time.

I understand that I am consenting to an elective treatment/procedure that is not urgent or emergent. I understand that it may put me at increased risk for becoming infected with COVID-19, due to potential community exposure.

PATIENT’S ACCEPTANCE OF RISKS

By signing this consent form I accept the risks described above and give my permission to proceed with the treatment/procedure.

I have read this consent or someone has read it to me and want to proceed.

Laser and / or BBL (BroadBand Light) therapy targets hair follicles for the purpose of selectively destroying them while leaving the surrounding tissue (skin) intact. The purpose of this procedure is to diminish or remove unwanted hair.

Review of facts about light therapy

• Hair reduction requires more than one treatment and does not remove all hair. Generally hair reduction is decreased in the amount of hair growth by 60-90% on average. Results depend on color and location of hair follicles. A general range of 4-12 treatments spaced 4-8 weeks apart is possible for maximum results.
• Light from a laser can be harmful to eyes and wearing special safety eyewear is necessary at all times during the procedures.
• Light from BBL is an intense burst of light and even though the special safety eyewear is in place, you will sense light emanating from the treatment area.

Common side effects and risks

• Erythema (redness) may occur in the area of treatment. This may last several hours. Edema (swelling) around the hair follicles is called peri-follicular edema and is a sign that the hair follicle has been affected. Urticaria (itching) or hive-like appearance is also associated with the thermal light affecting the surrounding skin. These symptoms usually subside in a few hours. A cool compress placed on the area provides comfort. The treated area should be cared for delicately for at least 12 hours. Limited activity may be advised, as well as no hot tub, steam, sauna, or shower use.
• A blister can form up to 48 hours after treatment. An antibiotic cream or ointment can be used. Other short term effects include bruising, superficial crusting, and discomfort.
• Hyperpigmentation (browning) and hypopigmentation (lightening) have been noted. These conditions usually resolve within 2-6 months. Permanent color change is a rare risk. Vigilant care must be taken to avoid sun exposure (tanning beds included) before and after the treatments to reduce the risk of color change. Sunscreen and / or sun block should be applied when sun exposure is necessary.
• Infection is not usual after treatment; however herpes simplex virus infections around the mouth can occur following treatments. This applies to both individuals with a past history of the virus or individuals with no known history. Should any kind of infection occur, your clinician must be notified to prescribe appropriate medical care.
• Allergic reactions resulting from treatment are uncommon. Some persons may have a hive-like appearance in the treated area as discussed above. Some persons have localized reactions to cosmetics or topical preparations. Systemic reactions are rare.

Alternative methods of hair reduction are: shaving, waxing, electrolysis, chemical epilation, and threading. I choose to try hair reduction therapy by laser and/or BBL light therapy. I understand that compliance with pre and post care instructions is crucial for success of hair reduction therapy and to prevent unnecessary side effects or complications. I understand that the hair reduction therapy involves payment and the fee structure has been explained to me.

I assume all risks as my own and agree to hold harmless, Pua Manu MedSpa. their providers, estheticians, and any other staff member, affiliate, or independent contractor. I hereby release them from any liability, both seen and unforeseen, now and forever.

I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all my questions answered to my satisfaction. I understand the procedure and accept the risks. I agree to the terms of this agreement.