Consent Form

Q-Switch

I HAVE BEEN ADVISED OF THE FOLLOWING:

  1. The possible risks of the procedure include but are not limited to pain, swelling, redness, bruising, blistering, crusting/scab formation, ingrown hairs, infection, and unforeseen complications which can last up to many months, years or may be permanent.
  2. There is a risk of scarring.
  3. Short term effects may include reddening, mild burning, temporary bruising or blistering. A brownish/red darkening of the skin (hyperpigmentation) or lightening of the skin (hypo pigmentation) may occur. This usually resolves in weeks, but it can take up to 3 – 6 months to heal. Permanent color change is a rare risk. Loss of freckles or pigmented lesions can occur.
  4. Although infection following treatment is unusual, bacterial, fungal and viral infections can occur. Herpes simplex virus infections around the mouth can occur following a treatment. Should any type of skin infection occur, additional treatments or medical antibiotics may be necessary.
  5. Pinpoint bleeding may occur following treatment. This may result in scarring.
  6. Compliance with the aftercare guidelines is crucial for healing, prevention of scarring, and hyper-pigmentation.
  7. I understand that multiple treatments will be necessary to achieve desired results. No guarantee, warranty or assurance has been made to me as to the end results.
  8. My questions regarding the procedure have been answered satisfactorily.
  9. I understand the procedure; I accept all risks and consent to undergoing treatment.
  10. I agree that photos may be taken as part of my treatment record and remain confidential.
  11. I have read and received a copy of the Client Information, After Care Instructions and Consent Form.
  12. I must wear eye protection as advised by my therapist.

 

IN RELATION TO MY INITIAL AND ALL SUBSEQUENT TREATMENTS I ADVISE THAT:

  • I am not tanned from any source, including sun exposure, spray tans, solariums etc. within the past 4 – 6 weeks.
  • I do not have a history of abnormal scarring.
  • I have not taken the drug Roaccutane in the last 12 months
  • I am aged 18 years or over (otherwise guardian to sign).