Electrolysis Intake Form

Zap Master Electrology is dedicated to providing permanent hair removal training and services under the expert care of Stephanie Shields, CPE CLS, our certified electrology instructor. If you are referred to us by your electrologist for a medical electrolysis assessment, once your treatment is approved by your insurance company, Stephanie will ensure that your ongoing treatments are redirected to your home clinic contracted with Zap Master consultation services.

*To proceed with your insurance coverage for hair removal, you'll need a Letter of Medical Necessity from the provider who will perform the procedure. This letter should detail the size and location of the treatment area, along with the expected number of units needed per body region for a comprehensive treatment plan.

Terminal Hair Growth Description:

Terminal hair refers to the mature, fully developed hair that is coarser, thicker, and darker compared to vellus hair, which is the fine, light-colored hair commonly found on various parts of the body. Terminal hair is typically found in areas influenced by hormones, such as the scalp, armpits, and pubic region. During puberty, hormonal changes trigger the transformation of vellus hair into terminal hair in certain areas, contributing to the development of secondary sexual characteristics.

Pictured below is an example of terminal growth 

PHOTO REQUIREMENTS (virtual consults and insurance requirements)

Photos of the requested area to be treated from approximately two feet (include a method of hair removal used in the following photo series for documentation): 

Before Hair Removal

• Face and neck: Recommend 8-12 hours of hair growth; include the length of time from last hair removal) 

• Body: Recommend 1-2 weeks of hair growth to visualize hair distribution, thickness, etc. Genital body region photos are not needed. 

Immediately after hair removal:

The client may remove the hair before bed for the “immediately after hair removal pictures.” Then in the morning, take pictures again to demonstrate the "before" hair growth. 

Phone Camera: Use to the camera on the backside of your phone. NO soft focus filters or "beauty" filters when takeing the pictures. The picture below is an example of the face pictures.  

The concept of using electric current for hair removal has been available since the late 1800s and has been improving ever since.

Electrolysis treatments are a form of electrical epilation where a single-use, disposable wire filament is inserted into the hair follicle (a natural opening in the skin) and a minimal amount of current is delivered to the root of the follicle to destroy it through a variety of modalities. All modalities will affect only the active hair follicle, making this a direct route to target unwanted hair.

In the early stages of treatment, you will be treating more frequently to break down their strength in the early stages of their growth cycle. It is imperative that we treat hairs in the recommended treatment pattern your electrologist determines necessary for your unwanted hair needs. This frequency will change as the number of hair lessons/weakens/ or both.

There are three types of electrolysis:

Galvanic Electrolysis - Galvanic electrolysis is the oldest type of this hair removal. The direct current used is extremely effective but slower. It creates a chemical change in the follicle to disable the root.
Thermolysis – 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 – This method combines both galvanic and thermolysis into one process. The heat from thermolysis heats up the chemical created in the galvanic and speeds up the process.
Your electrologists will select the modality that best serves the hairs requested. There may be contraindications that keep you from a modality which is why we request your health history information pertinent to our work. It is not uncommon to use all modalities when working on one client.

1. I understand health history information is important in order to provide me with safe and effective treatments.               
2. I acknowledge all information given by me is accurate to the best of my knowledge.  
3. I agree to update my client profile whenever there are changes.
4. I know that hair removal will take a series of treatments to achieve satisfactory results.
5. I have been told that the success of my treatments will depend on my cooperation with my treatment schedule, my pain tolerance, inherited hair growth patterns, and any other instructions explained to me or recommended by the technician.
6. I have been advised of the post-treatment healing process, the possible risks related to treatment, and I agree to follow all after-care instructions given to me by the technician.  I will notify the provider of the treatment of any difficulties in healing.
7. I understand and acknowledge that all deposits and payments for the above procedure are non-refundable unless I cancel my appointment at least two days prior to the procedure.
8. I acknowledge that all the information provided is to the best of my knowledge, and that it is important to keep this information up to date, especially medications, medical conditions and pregnancies, at each appointment.  
9. I also acknowledge that I accept full responsibility for my care.

Please notify within the time frames listed below when canceling or changing an appointment:

• 24 hours notice for appointments one hour or less.
• 48 hours notice for appointments more than one to less than three hour(s).
• 5 days for any treatment 3+ hours

This allows for adequate notification will allow for any openings to be filled.

A $35.00 charge will be incurred for any violations of our cancellation policy for appointments with the electrologists, nurses or aestheticians for appointments of two hours or less.

Being late for an appointment is included in the treatment time.

Reminders that are sent out days prior to your appointment.However we do expect you aswell to note your appointment date and time. You are equally still responsible for your appointment whether or not you receive your reminder.

Invoices are sent to violations of the above polices and must be PAID IN FULL. Repeated offences (3 or more) will result in the cancellation of future appointments until you are able to resume a commitment to your electrolysis scheduled goals. 

Self pay customers: Three violations of our cancellation policy or “no shows” will require prepayment of the treatment.