Cons
hair removal
consultation form

IPL

to provide you with a very safe service with the best possible results please provide the following information

What method of hair removal do you currently use (if applicable tick below)
Is there a family history of superfluous (excessive) hair?
Do you have any current or chroice medical illnesses?
Are you currently under a doctos care?
Are you taking any photosenstizing medications? (ie. anti depressants, St. Johns Wart, etc
Permaent make up, implants or tattoos?
Botox, dermal fillers etc or chemical peels (within 12 months)
Do you smoke?
Do you drink?
Do you have any allegies?

Medical Informed Consent

I consent and authorise Dermal Remedy to perform IPL hair removal treatments on me.  I understand the following points and I will have had the opportunity to ask questions during my consultation.

In relation to IPL hair removal treatments, I have been advised as follows:
1.  Treatment are successful on most clients but my individual results cannot be guaranteed
2.  Most clients require 8-10  treatments to achieve up to 80% hair reduction, some may require more.  Hair loss is variable and individual results depend on may factors, thus it is extremely difficult to advise on exact number of treatments required.
3.  Light blonde, grey, red or white hair does not respond to IPL treatment
4.  Fine facial hair takes longer to respond to treatment than hair in other areas and will require additional treatments
5.  Darker skin type clients will require additional treatments
6.  Exposure to UV Rays will compromise my treatment, therefore I will use SPF 30+ sunscreen
7.  Growth of dormant follicles that may be triggered by hormonal changes (eg. stress, illness, medications, pregnancy, trauma or other causes) can stimulate future hair growth
8.  Not following the program regarding timing of treatments will reduce efficacy of treatment
Risks associated with IPL hair removal treatments. Please tick that you have read and understand the following:
In relation to my initial and all subsequent treatments I advise that; Please tick that you have read and understand the following:
Consent

Your Signature

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