Electrolysis Questionnaire

Why Choose Laser Hair Removal?
Key Benefits:
From silky-smooth skin to freedom from outdated methods and saving time and money, the benefits of laser hair removal are unmatched!

Laser hair removal gives you permanent results. Because each hair follicle is targeted, that hair can’t grow back, leaving you with soft, beautiful skin for life.

The results are permanent, so you don’t have to keep paying for razors, shaving cream, or waxing appointments, which saves you hundreds of thousands of dollars over a lifetime.

Each laser pulse takes just a millisecond. Treatments are much faster compared to shaving, plucking, waxing, and at-home laser hair devices.

Shaving and waxing are hard on your skin. With laser hair removal, you can avoid ingrown hairs, razor burn, cuts, strawberry skin, and other skin irritations.

What Exactly Does Laser Hair Removal Do?
Laser hair removal is an effective, common procedure to remove unwanted hair. It targets pigment in hair follicles. The concentrated light is converted to heat, which destroys the hair follicle and prevents future hair growth.

Does Laser Hair Removal Permanently Remove Hair
Results from each laser hair removal session are permanent. The laser targets pigment in each hair follicle, and the heat destroys the follicle, disrupting the growth cycle. The average client is up to 95% hair-free in 6 to 10 treatments.

How Many Sessions Do I Need?
The number of laser sessions needed will vary from person to person. Generally, clients see up to 30% hair reduction after their first treatment. After 6 to 10 treatments spaced five weeks apart, clients are up to 95%+ hair-free and may only require maintenance treatments.

Is Laser Hair Removal Painful?
Many describe the sensation of laser hair removal as similar to a rubber band snapping against the skin though modern devices use cooling systems to minimize discomfort. Compared to painful waxing, laser hair removal is tolerated well by most people and treatments are faster.

Consultation & patch test
Find out about your free laser hair removal consultation with Virtuoso Beauty & Co, and why our comprehensive skin patch test goes even further to ensure your safety and happiness.

What happens in a consultation?
All potential clients will undergo a full consultation prior to any laser hair removal treatment. This allows the practitioner to determine the following important factors:

Contraindications (to ascertain if the procedure may be harmful to you)
Skin type
Hair type

Did you know?
Our consultations are always free, and we'll patch test every area of your body that requires treatment!

During the consultation process, the practitioner will discuss the following with you:

Treatment goals and expectations
Current method of hair removal
The hair cycle and skin
How laser hair removal treatment works
Different types of laser technology
The treatment process and factors that wil determine your results
Details about your medical history (including any current medications)
Pre-treatment requirements
Aftercare requirements
Cost and frequency of treatments
Predicated results of the treatment
Once this is completed and you are happy to proceed the practitioner will seek your informed consent to undertake a patch test, or tests if you would like treatment on different areas.

The consultation process typically takes an 20 minutes.

What is a patch test?
A patch test is carried out after conducting a consultation with the laser practitioner. There are a couple of reasons for carrying out a patch test, the first is for the practitioner to determine what the most effective settings for the laser parameters are in relation to your hair and skin type. A professional laser practitioner will effectively carry out a patch test for each and every area of treatment. This is because your hair and skin are not the same everywhere on your body.

Secondly, a patch test will indicate to you and your practitioner any adverse side effects or problems prior to a full session. Since it is carried out on a small patch of skin, if there are any problems they will be minimal. The test is done at least 48 hours before your first treatment, so that any reactions have time to appear and your treatment plan can be adjusted if necessary to ensure effective results with minimal side effects.

When do I get the patch test?
A patch test will be carried out at your initial consultation, after your details have been taken, including your medical history and any current medications. When your laser practitioner has gone through everything with you and answered all your questions, a patch test will then be performed on the areas which you are considering having a treatment on. This is a minimum of 48 hours prior to the commencement of your first session.

Do I need to do anything to prepare for my patch test?
You should make sure that the area to be treated is clean and shaved. It is vital that you do not remove any hair from the root in the run-up to your treatment, so no plucking, epilating or waxing. This is because the root is needed for the laser to do its job.

Do I need to ask the laser practitioner anything?
This is really up to you, but we would highly recommend having a good conversation with your practitioner and getting any questions or concerns you have addressed prior to the patch test.

Things that are usually nice to know include if the person doing your consultation will be your permanent laser practitioner. What level of experience and training has she/he undertaken? Why is Nd:YAG 1064nm considered a more effective laser? Here are a list of essential safety questions you should be asking during your consultation.

Is there a cost for a patch test?
Our consultation and patch test are free of any charges.

Here at Virtuoso Beauty & Co. we believe in providing our clients with a professional and personal service. We will simply undertake a patch test on one point of your body; generally be somewhere on your arm. We are relentless in our pursuit of best practice, and will conduct a patch test on all the different areas of your body where you are considering undertaking a treatment. As you'll have noticed, the skin and hair on each part of your body can be very different.

What happens following the patch test?
The practitioner will contact you 48 hours after the patch test to get some feedback and ascertain if there were any adverse reactions to the patch test. If you are satisfied the practitioner will book you in for your first session towards your goal of permanent hair reduction. Session are pre-paid in order to be scheduled.

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Post Code

E-mail*

example@example.com

Phone Number*

Date of Birth*

DayMonthYear

Have you had previous laser hair removal? If so, please explain.*

YesNo

Please provide details

What areas are you looking to have treated for laser hair removal? *

Do you have any Hormonal imbalances? If so please explain.*

YesNo

Please provide details

When was the last time you were exposed to the sun excessively ?*

This weekPast 2 weeksNo exposure in past Month

Please provide details

Are you using any retinols/ hydrocortisone/ Retin-A/ Accutane/ Blood thinners/ bleaching cream or any prescription Topicals on skin? If so please, explain.*

YesNo

Please provide details

Any cosmetic tattoos/ permanant makeup in area being treated? *

YesNo

Have you taken any antibiotics in the last 14 days?*

YesNo

Please provide details

Are you taking any prescribed medications or dietary supplementation?*

YesNo

Please provide details

Are you waxing, tweezing, shaving, or doing any depilatories on the area you want treated? If yes, please specify what you are doing and how often hair is being removed.*

YesNo

Please provide details*

Are you pregnant or breastfeeding?*

YesNo

Have you had any Botox, Dermal Fillers, Skin Resurfacing, or Chemical Peels in the past 6weeks?*

YesNo

Please provide details

History of HSV (Cold sores/ Fever Blisters)*

YesNo

Do you have any other medical conditions, injury or any other information that the practitioner should be aware of that we have not mentioned?*

YesNo

Please provide details

CONSENT FORM
Electrolysis treatments are a form of electrical epilation with a minimal amount of current being delivered to the root of the hair to destroy it through a variety of modalities. All modalities will treat only the offending hair follicle, making this a non-invasive and more direct route to target unwanted hair. ONLY ACTIVELY GROWING hairs and follicles can be treated by an electrologist and multiple sessions will be necessary.
Galvanic Electrolysis: Galvanic Electrolysis is the oldest type of electrolysis. The Direct Current used is extremely effective but very slow. It creates a chemical change in the follicle to disable the root.
Thermolysis Electrolysis: Thermolysis uses shortwave radio frequency or AC current. Thermolysis causes the water molecules by your hair to rapidly vibrate, which produces heat. When enough heat is created, thermolysis damages the cells that cause hair growth.
Blend Electrolysis: True to its name, blends and combines both Galvanic and Thermolysis in one treatment. If one type of electrolysis doesn't kill your unwanted hair the other method will.

What to expect
A common experience is redness, swelling, bruising or all of the above. These are all natural reactions from the stimulation applied to follicle. It can be eased with the use of an ice pack and after treatment gel 2-3 times daily. In order to prevent any additional reaction, it is critical that you inform us of any medical conditons, medications, supplements, lotions and oils.
Post Treatments
Avoid Direct Sunlight
Avoid exercise and or anything that may cause sweating within 24hours.
Keep area washed and clean
Use ice-pack if necessary
After Treatment-Gel is recommended 2-3 times daily
DO NOT pick, rub or scratch area (scabbing is normal and part of healing process.

I understand that laser is not down to an exact science therefore everyone responds differently; we cannot guarantee 100% reduction.*

Yes

I understand that results are reliant on the accuracy of information I have provided the Electrolysis Center regarding my medical history and my adherence to proper before and after care.*

Yes

I understand that possible side effects may include but are not limited to: Inflammation to the hair follicle, swelling, erythema ( redness), as well as pink or red coloration which will typically begins 15 minutes after the treatment and last a few hours*

Yes

I understand to avoid excessive sun exposure 2-4 weeks before and after treatment and I will avoid anything that will raise my body temperature such as, exercise, hot tubs/showers/saunas, and sex for 24 hours after treatment.*

Yes

I understand that the frequency and longevity of treatments is determined solely on my body's natural hair growth and therefor not predetermined by the Clinic.*

Yes

I understand and comply with Virtuoso Beauty & Co. 24 hour cancellation policy, that, if I am a LATE CANCEL or a NO CALL NO SHOW I will be charged $25.00 additionally and will pre pay prior to scheduling next appointment.*

Yes

I Acknowledge that Virtuoso Beauty & Co. will keep card on file for future appointments for contactless payment and for the cancellation policy as stated above.

Yes

I Acknowledge that I have read, understand and accept the terms above regarding Electrolysis Hair Removal. I hereby consent to and authorize the electrologist(s) to perform Electrolysis Hair Removal treatments related to before and after treatment services on me.*

Yes

Signature*

I (your name) your name* understand that I will have before and after photos taken for the technician at Virtuoso Beauty & Co. files to track progress of treatment.
Intimate areas are excluded for privacy.

I consent to give permission to use these photos for advertising and marketing. Photos to be used will be strictly of areas being treated. (Not to include identifying facial/ body features)

YesNo

I (your name) your name, Grant permission to the Virtuoso Beauty & Co. and its agents, La Beau Monde LLC and employees the irrevocable and unrestricted rights to reproduce the photographs and/ or video images taken of me, during my treatment, for the purpose of: publication, promotion, illustration, advertising, or trade, in a legal manner. I hereby release the Electrolysis Center and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during the capture/ recording moments, without my name, for the purpose of advertising publicly without restriction. I waive my right to any compensation.

I acknowledge that I am:*

Over the age of 18The Legal Guardian of the following

If Legal Guardian or client (s) Please list name(s) your name . blank