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Informed Consent

Skin Treatments

Acknowledgment, Waiver, and Consent to receive Skin Rejuvenation procedure and treatment at Ease Medspa Wellness. Please do not sign this form without reading and understanding its contents. 

1. This is an informed consent document which has been prepared to help inform you about laser, light and equipment based treatment procedures of skin, risks, and alternative treatments. 

Please read this information carefully and completely before you sign the waiver and consent to receive skin rejuvenation treatments at Ease Medspa & Wellness Group.  

We use FDA approved advanced laser technology for the laser treatments: Improving fine lines & wrinkles, skin texture and diminishing scars, photo rejuvenation, acne scars, remodeling collagen, stretch marks, age spots, Sun damage, etc.

2. What Skin Treatments we perform?

The M22® IPL™photofacial treatments targets brown and red pigment in the skin. They can also target the bacteria that causes acne, reducing its severity, along with stimulating collagen production, to help firm skin and reduce fine lines and wrinkles. 

The Lumenis® ResurFX™ treatment is a fractional skin rejuvenation solution that addresses the early sign of aging, helps even out hyperpigmentation (such as sun spots, melasma), smooth wrinkles, fade stretch marks and mild acne scars.

The Lumenis® Q-Switched ND: Yag treatment can remove tattoos and pigmentation. It's safe for most skin tones and can treat dark tattoo inks. Tattoos typically fade over time after each session, and treatments are usually scheduled every 6-8 weeks.

The treatment can also treat pigmented lesions and skin toning.

The Cutera® Laser Genesis™ is a non-ablative procedure that can reduce visible facial vessels, correct the symptoms including diffuse redness, fine lines and wrinkles, enlarged pore size, uneven skin tone and texture, improving the appearance of your skin.

The DiamondGlow™ is an advanced skin-resurfacing treatment with the 3X1™technology that exfoliate, extract debris, and infuses the skin with medical-grade serums, volumizes skin by 70% with no downtime.

The BioRePeel® is the latest and a complete Italian-made aesthetic peeling treatment for all skin types with minimal-zero downtime. It targets the dermis with the goal of stimulating new skin growth and improving the skin surface texture, imperfections, and accelerates cell turnover. It delivers an instant result and continue to improve over the following weeks.

The PCA Peels / Glow Peels treatments can be used to diminish the appearance of fine lines and wrinkles, improve skin tone, reduce pore size, increase hydration and moisture retention. Layers of product are applied based on your unique skin composition and needs.

The purpose of the above mentioned procedures is to improve the appearance of photo-aged skin by clearing the superficial pigmented and vascular lesions, promoting collagen growth and thus improving the skin texture. However, the degree of improvement and the number of treatments required vary in clients with variables such as age, life style, condition of skin, sun damage, smoking, skin care routines and general health... you acknowledge that there are no guarantees, warranties or assurances that you will be satisfied with your results.

3. Pre-Procedure Instructions:

  • Treatment area needs to be fully washed off (or shaved if it's necessary) and has no makeup, foundation, creams, etc.
  • Avoid the sun exposure or tanning booths for 4 weeks prior to treatment.
  • Use a broad spectrum UVA/UVB sunscreen with an SPF of 50 or higher. Apply to the treatment area every 2 hours when exposed to the sun and it is recommended to make this a part of your skin care routine.
  • We do not recommend to have laser treatments if you are on medications such as Accutane, Retin-A, Gold Therapy etc, at present or within the past 6 months. These medications and several others, can make your skin susceptible to damage from the laser. The list of the aforementioned medications is available upon request.
  • Laser treatments cannot be given during your pregnancy.
  • If you have a history of herpes or cold sores, you may need antiviral medication. This medication should be started one day before laser treatment and continued for one week after treatment.

4. Post-Procedure Instructions:

  • There may be redness or swelling around the treated area after the treatment, it may become pink, red, inflamed, or even blistered and may last several hours to several days, apply the ice, cooling gels, Hydrocortisone or Neosporin to relief. Do Not allow ice packs or ice into direct contact with the skin.
  • Immediately post-treatment, apply a broad specturm (UVA/UVB) SPF 30 (or higher) and recommend to apply on a daily basis, re-applying every 2-hours if outside.
  • If any blistering or scabbing develops, do not rub or pick on the area. Apply Aquaphor ointment or other moisturizer to the treated area 2-3 times a day. Keep the area moist and let the crusting/scabbing resolve on its own.
  • After treatment, the skin will be more sensitive to the heat and feel similar to a sunburn, keep away from the oven for 24 hours, and maintain a cool water temperature when taking a shower or bath.
  • Avoid any sweating activities that cloud lead to excessive perspiration.
  • Direct and prolonged sun exposure should be minimized throughout the duration of the treatment regimen.
  • Keep the treatment area clean; Use gentle cleanser followed with a gentle moisturizer (e.g., CeraVe®, Cetaphil®) twice a day for 7-10 days.epid water for bath or shower with gentle wash.
  • Client can resume their regular skin care regimen 7 days after treatment. Makeup can be used after 24-48 hours depending on the skin response.
  • Some clients experience dryness and itching of the treatment area up to 4 weeks post treatment. Avoid plucking, rubbing or scratching the area to prevent from further complications.
  • Avoid any irritating medications or chemicals, such as Retin-A, Benzoyl peroxide, glycolic acid or astringents for 7 days Pre and Post treatment. 
  • With any acne treatment, post Inflammatory flare ups typically occur 7 or more days after treatment, and can last up to 3 weeks. It's recommended only use non-comedogenic skin products during skin recovery period.
  • Avoid treatments that may irritate the skin for 1-2 weeks after treatment (such as waxing, depilatories, etc.)
  • The treated area should be ready for the next session in about 4-6 weeks.

Client should contact our office with any concerns, such as blistering, excessive or prolonged redness/swelling, etc.

Consent to receive Skin Treatment:

I understand that the service requested to be performed on me by Ease Medspa & Wellness Group is purely elective, and I clearly understand that the following problems may occur with the skin treatments:

  1. Short term effects may include but not limited to: Pain, edema (swelling), erythema (redness), rush/bumps, pigment changes, temporary bruising, blistering or scarring, or unknown risks. Avoid sun exposure before and after treatment as exposure to the sun may intensify the pigment changes. It is rare that a change is permanent. 
  2. Infection: 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, also known as activation of cold sores. This applies to both individuals with known or un-known history of herpes simplex virus infections in the mouth area. Please inform us if you have ever had a problem with cold sores. Should any type of skin infection occur, additional treatments or medical antibiotics may be necessary. This reactivation can be avoided by taking an Anti-viral prior to the procedure.
  3. Transient acne flareups: Mild flareups of inflammatory acne lesions are common after acne treatment. If acne flareups occur, they typically maximize 2-5 days after treatment and resolve over 2-3 weeks; however, acne flareups can continue at perceptible levels for several more weeks.
  4. Temporary skin dryness: Temporary mild skin dryness is common after skin resurfacing treatment, if it occurs, it's normally notices 1-5 days after treatment and typically resolves in 1-2 weeks with application of topical skin moisturizers (e.g. CeraVe®, Cetaphil®), however, it may persist up to 4 weeks.
  5. I understand that mild crusting or scabbing may occur during healing process. If crusting/scabbing occurs, it should be allowed to naturally slough without picking, to minimize the likelihood of skin pigmentation changes of infection.
  6. I understand that mild to moderate blisters are very rare but it may develop, and care should be taken not to disturb or unroof the blisters to prevent oozing and possible infection. Oozing from blisters that are disturbed or unroofed lasting more than a day.
  7. Skin texture/Hyperpigmentation: Darkening of the skin (hyperpigmentation) or skin texture changes can occur during the recovery period. If it occurs, it may last for one to several months before normal pigmentation levels return. Your treating technicians may recommend topical skin products to accelerate the return to normal levels.
  8. Scarring is a rare occurrence, but it is a possibility whenever the skin's surface is disrupted. To minimize the chances of scarring, it is important that clients follow all post-treatment instructions provided upon the treatments. Good post-treatment care will help reduce the possibility of scarring.
  9. Bruising: broken capillary blood vessels may lead to transient "mini-bruising". Sun avoidance is essential in that case.
  10. I understand that exposure of my eyes to light could harm my vision. I must keep the eye protection goggles on at all times.
  11. I confirm that I have not taken Accutane within the last 6 months, and that I do not have a pacemaker or internal defibrillator. 
  12.  I confirm that I am not on antibiotics at this time.
  13. I confirm that I am Not pregnant at this time, and I will inform Ease Medspa Wellness if I become pregnant in the future so I can stop all laser treatments. 

Acknowledgment:

  • 24-hour Cancellation & Rescheduling Policy: I do understand that my appointment is one-on-one service and it is my responsibility to remember the appointment dates and times. I must Call, Email or send Message at least 24 hours prior to my designated appointment if I need to Reschedule or Cancel. 
  • No Show Policy: I understand that if I miss my appointment without canceling 24-hours in advance, it will be recorded as a “No Show” in my file. 
  • I do understand the 24-hour policy, and I agree to pay the appropriate fee of $30-$50 if I fail to cancel or reschedule 24 hour in advance. The same rule applies to No Show appointment.
  • No Refund: I do understand all sales are final and not refundable. 
  • No Guarantee: I understand that there is No guarantee can be made concerning the results of the treatment. Optimal results are achieved with a series of treatments, and the total number of treatments will vary between individuals. 

By signing this consent form, I authorize Ease Medspa & Wellness Group and its trained, licensed staffs in this practice to perform the skin rejuvenation procedure on me. I understand it is valid for all of my future skin treatments at Ease Medspa & Wellness Group, and I do understand it is my responsibility to inform the staff if any medical or prescription changes. 


I confirm that the Pre & Post-procedure instructions have been provided to me by Ease Medspa & Wellness and I understand all such instructions. it is my responsibility to follow these instructions, and that my failure to adhere to these recommendations may result in complications and contraindications for which I am fully responsible.

I confirm that my questions regarding skin treatment procedures including the benefits and potential risks, side effects, possible complications associated with skin treatments have been answered satisfactorily. I understand the skin treatment procedures and accept the risks. I, and any of my heirs, executors, representatives or assigns hereby release Ease Medspa & Wellness Group Inc. from any and all injuries, actions, causes of action, suits, damages, judgments, claims, and demands whatsoever, in law or equity, while on the premises during the skin treatments performed by any practitioners of Ease Medspa & Wellness Group Inc.


Dated: November 8, 2024

First Client's Name

First Name*

Last Name*

Phone*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Client Questionnaire

Is your skin tanned on your treatment area(s)?*
No
Yes
Which skin treatment(s) would you be interested in?*
BioRePeel
M22 IPL(Photofacial)
Lumenis ResurFX
Laser Genesis
DiamondGlow
Laser Pigmentation Removal
PCA Peels / Glows Peels
Dark Tattoo Removal
Laser Hair Re-grow
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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