ACKNOWLEDGMENT, WAIVER, AND CONSENT TO RECEIVE LASER HAIR REMOVAL PROCEDURES. DO NOT SIGN THIS FORM WITHOUT READING AND UNDERSTANDING ITS CONTENTS.
1. Company Policies:
I do understand the 24 hours prior notice (48 hours prior notice for appointment takes over 1/2 hour) is required to cancel or reschedule of my designated appointment, and $20 or ($40 for appointment takes over 1/2 hour) cancellation fee will be applied ifI fail to cancel or reschedule within the specific time frame. The same rule applies to NO SHOW appointments. As a courtesy, we will send email reminder/ text message to confirm your service appointments two business day prior to your appointment date. Please understand that it is your responsibility to text or email us when you need to modify your appointment to avoid the cancellation fee.
***Please save our text number (551)230-6569 /email address email@example.com as point of contact***
Online Promotion Voucher from Third Party:
- Limit to one voucher per person per 12 months, additional purchase or gifted voucher(s) will not be honored but it can be either used as store credits or refunded through online merchant.
- Limit to selective treatment areas (XL areas will be excluded from any promotional package) if the desired treatment area is not on the “AREA SELECTIONS LIST”, client can exchange or upgrade the package in the store.
- All treatments MUST be used on the same area and on the same person.
- Voucher will be redeemed and sales tax will be collected after completing the first treatment.
Clients should have a CLEAN SHAVE one day before their appointment(s). It allows the maximum amount of laser energy penetrate to burn the hair follicles instead of hair shafts. Fail to shave will be subject to rescheduling or a shaving fee. ($15 for small area, $20 for medium area, $30 for large area, price may vary for extra large area.)
I do understand all sales are final and nonrefundable. There will be no refund or reimbursement to the unfinished yearly package(s), voucher, or deals if you become ineligible for laser treatment or physically impossible to continue the treatment within the stated period.
I do understand that taxes, gratuities and shaving fees are NOT included in any service I purchase. Tipping is not mandatory but it is customary in most circumstances for service. It's generally good form to tip 10%-20% of the service fee. Gratuities are accepted in the form of cash or credit card.
2. Laser Hair Removal Informed Consent
- I authorize Bared Monkey MedSpa Inc. to perform laser hair removal procedure on me. I understand that this procedure works on the growing hair and not on dormant hair. Complete removal of all hair follicles is unlikely.
- I understand that the clinical results and total numbers of treatments will vary between individuals depending on individual hormonal level, skin type, hair type, hair density, hair coarseness, age, genetics, medical conditions and other factors. Typically most of the clients require a minimum of 6 to 8 sessions to achieve a long-term, stable reduction in hair growth. For hormonal areas, such as face, bikini area, men's chest or back may require more sessions, and consistent touch-up may be necessary for these areas.
- I understand that laser hair removal is not exactly permanent as our body will continue to repair the damaged hair follicles and future hormonal changes may stimulate new hair growth, therefore, it's important to follow up after the full initial round of laser treatments to maintain the optimum result.
- I understand that grey, blonde, red hair cannot be treated with the laser. There is limited result for fine hair (peach fuzz). In some cases, this can reactivate dormant hair follicles and induce new hair growth.
- I understand that tanning over the course of treatments is not recommended and can cause a number of complications. Scheduled treatment may be postponed if the patient is tanned. Tanning and sun exposure should be avoided 2 weeks before and 2 weeks after each treatment. Sunblock with SPF 50 or higher should be used on treated area during the course of laser treatments. It is my responsibility to inform the treatment provider if the skin is darker than when treatment was first started as well as any medical or prescription changes during the course of treatments. Improper post-treatment care may increase the chances of any complications.
- I understand that If I am pregnant/breastfeeding, I am NOT a good candidate for laser.
3. Alternative Procedures
Laser Hair Removal (LHR) is a non-invasive laser treatment designed to remove unwanted hair from all parts of the body. It's one of the best options to reducing and slowing hair growth over an extended period of time. During LHR, the laser emits a light that is absorbed by the melanin in the hair and light energy is converted to heat which damages hair follies and inhibits or delays future hair growth. We carried three different top of the line FDA cleared Laser Hair Removal equipments, ALMA Soprano, Candela Gentle Max Pro, Lumenis Splendor X, and we offer different types of laser wavelengths, Alexandrite Laser, ND-YAG laser and Diode Laser to help our clients to achieve the best results with safety and comfort level in mind. Here are the differences among 3 laser wavelengths:
The ND-YAG (1064nm) laser has the longest wavelength, which is safer to treat clients with Skin Type V and VI (deeper skin complexity) and more effective to treat deeper embedded hair follicles due to deeper penetration. It’s gentle to treat all skin types. However, it is less effective on light-pigmented hair. It causes more discomfort during treatment, usually numbing cream is recommended. Cooling is provided with the DCD Cryogen freezing spray (Candela Gentle Max Pro), or cool air from Zimmer (Lumenis Splendor X).
The Alex (Alexandrite) (755nm) laser has shorter wavelength which is the most effective to treat light-pigmented hair/superficial hair follicles due to high melanin absorption. However, it involves a higher risk of injury of epidermal skin due to its superficial penetration. Not suitable for clients with Skin Type V to VI or tanned skin. Cooling is provided with the DCD Cryogen freezing spray (Candela), or cool air from Zimmer (Lumenis Splendor X).
The Diode Laser (810nm) laser is more effective for Terminal Hair (longer, coarser and darker hair). There are limited results on Vellus hair (short and fine with little or no pigment hair), and less effective on skin type V and VI. It allows a more comfortable treatment due to its groundbreaking technology- the sweeping In-motion™ technique of moving the applicator repeatedly over the treatment area ensures full coverage while ICE™ technique cools the skin surface preventing superficial burns, yet highly effective hair removal. Usually, the numbing cream is NOT required in general. Cooling is provided with water contact cooling system (ALMA Soprano) and combined with a cooling gel.
LHR is a voluntary cosmetic procedure which is not necessary or required, here are other alternatives for hair removal practices: Electrolysis, waxing, plucking, threading etc.
4. Contraindications of Laser Hair Removal
You may not be the best candidate for laser hair removal if any of the following contraindications pertain to:
- Hormonal imbalance, PCOS, Hirsutism, pregnancy, menopause, and other endocrine conditions can affect the treatment outcome.
- Pregnancy and nursing
- Use of Accutane (must discontinue use of product 6 months before beginning treatment)
- Use of photosensitive medications (i.e. Anti-biotic, Retinoids or other Acne medications, Antihistamines, Cancer chemotherapy drugs and other cancer drugs, Diabetic drugs, Statins, Malaria medications, Cardiac drugs, St. John Wort etc.) may cause an increased risk of side effects to the laser (must discontinue use of product 4 weeks before beginning treatment)
- Epilepsy or those who have a history of seizures
- Poorly controlled Diabetes
- Current (active) skin cancer within one year or pre-malignant moles in the treatment area. A medical clearance letter is required.
- Active sores or rash (psoriasis, eczema) in the area to be treated
- Skin disorder such as keloids or abnormal wound healing
- History of melanoma, active or inactive anywhere on the body
- Recent (within 1 months) surgery, laser resurfacing or deep chemical peels in the treatment area
- Severe medical disorders such as poorly controlled heart conditions
- Chemo or radiation therapy (letter of clearance from your physician is required)
- Pacemaker, internal defibrillator, and any internal electrical devices
- Any internal metal device, i.e. surgical screws, pins, plates, or implants, in the area to be treated (no treatment if any device is superficially in the body area to be treated)
- Aids, HIV positive or use of immunosuppressive drugs (a letter of clearance from your physician is required)
- Multiple sclerosis ( a letter of clearance from your physician is required with confirmation that the area to be treated is not numb)
- Immune disorders such as Scleroderma, Lupus, Porphyria, Sarcoidosis, and others
- Treatment over moles or lesion of any kind
- Treatment over tattoos, port wine stains, under the eyebrows, or any orifice
- Bleeding problems or use of blood thinners
- History of disease stimulated by heat, such as recurrent Herpes Simplex in the treatment area. You may treat this area only following a prophylactic regime.
5. Risks and Complications
All medical and cosmetic procedures are associated with certain risks and may result in complications. Possible risks and complications associated with laser hair removal procedure include:
- Temporary reddening, burning, swelling, bruising or discoloration of the skin over the treated area.
- Blistering, scarring, activation of cold sores, infection or permanent discoloration, which may occur in rare cases. Please inform us if you have ever had a problem with cold sores.
- Folliculitis, which is an infection of the hair follicle, which may take several days to resolve.
- Hyperpigmentation (darkening of the skin) or hypopigmentation (lightening of the skin), these changes are often transient and improve with time, although permanent pigmentary changes may occur.
- Crusting or blistering of the area exposed to the laser, which is rare and which may take several days to heal.
- Paradoxical hypertrichosis, induction of terminal hair growth is not common but may occur.
- As with all LHR procedures, some re-growth of hair may occur after treatment sessions are completed.
6. Pre-Procedure Instructions
It is IMPORTANT that you follow all pre-treatment and post-treatment instructions carefully to minimize the chances of complications and achieve the optimum results from treatments.
6 months before:
4 weeks before:
- Avoid waxing, plucking, using depilatory (hair removal cream) or other hair removal practices.
- Avoid photosensitive medications (i.e. Anti-biotic, Doxycycline, Tricyclic antidepressants, Quinidine, Amiodarone, St. John Wort etc.)
- Avoid other laser treatments/ Microdermabrasion/ Chemical Peels/ Botox/ Filler on the treatment site
2 weeks before:
- Avoid sun exposure, tanning beds, self tanner such as creams or spray.
- Avoid skin irritants (i.e. Products contain tretinoin, retinol, benzoyl peroxide, glycolic/salicylic acids, astringents, etc.)
- Avoid Anticoagulants
24 hours before:
- The area to be treated must be CLEAN SHAVED the day before your treatment.
- If you have a history of Herpes Simplex Virus or cold sores, you must premeditate one day prior to treatment to prevent further outbreaks.
Day of treatment：
- Remove any lotions, body oil, perfume, make-up, deodorants and jewelry in the areas to be treated prior to treatment
- Wear loose fitting clothing that will leave the treatment area exposed and easily accessible for treatment. Tight or rough clothing may cause you to feel uncomfortable if the skin becomes sensitive after treatment.
- During your treatment you can expect slight discomfort, similar to a rubber-band snap on your skin. If you have sensitive skin, you may apply a topical numbing cream 30 minutes prior to treatment time in order for it to take effect.
Immediately after treatment, there should be erythema (redness) and edema (swelling) at the treatment site which may last 2 hours to several days. The erythema may last up to 2-4 days. The treated area can feel like a sunburn for several hours after.
Rarely, minor epidermal blistering may occur in which case antibiotic ointment may be applied twice a day to the affected areas. DO NOT pick at these areas, as this may result in infection or scarring. If this should happen, please contact our office immediately and our aesthetician will give you further instructions.
- It's recommended to apply an ice pack if the treated area is extremely warm and it's not cooling down within 15 minutes.
- It's recommended to apply Aloe Vera or Hydrocortisone1.5% post-treatment 3 times daily to smooth irritations.
- For the first 10 days after treatment, your body will push out the dead hairs from follicles. During the shedding phase, hair may look like it's growing, but it is actually shedding out. It’s recommended that you gently exfoliate the treated area 2 to 3 times per week starting from the 2nd week to help the dead hair fall out quicker and easier. Applying moisturizer after exfoliating will help skin replenish.
- Apply sunscreen daily. It should be at least SPF 50 protects UVA/UVB and contains the physical blockers zinc oxide and titanium oxide.
NOT TO DO:
- Avoid any activities that will cause sweating (i.e. exercising, hot shower, hot saunas etc.) for a minimum 12 hours.
- Avoid skin irritants (i.e. glycolic, acids, retinoids, etc.) for 7 days after treatment.
- Minimize shaving (try to leave the hairs alone and ONLY shave the day before your next appointment). Excessive shaving may stimulate the hair growth.
- Avoid plucking, waxing, using a depilatory or undergo electrolysis in between treatments.
- Avoid sun exposure 2 weeks after laser treatment
7. Treatment Interval and Follow Up Interval
Recommended treatment intervals:
- Every 4 weeks for facial areas;
- Every 6 weeks for body areas;
- Every 8 weeks for the legs.
Recommended follow up intervals:
Patient may achieve partial hair clearance or almost complete hair clearance after 6 to 8 sessions.
- If there has been partial hair clearance, treatment should be continued between 6 to 8 weeks until optimum result (80-90% hair reduction) is achieved.
- Once optimum result is achieved, patients can return for a follow up 3 to 4 months later, or when there is around 15-20% of hair regrowth in the treatment area.
Please keep in mind, laser hair removal is not exactly permanent as our body will continue to repair the damaged hair follicles and future hormonal changes may stimulate new hair growth, therefore, it's important to follow up after the full initial round of laser treatments to maintain the optimum result.
By signing below, I certify all information is true and correct to the best of my knowledge:
- I certify that the information contained in this Informed Consent was explained to me using terms I could understand, and all my questions and concerns have been answered. After reviewing all the information provided to me about cosmetic procedures and reviewing my health status, I believe I am a good candidate for Laser Hair Removal procedure.
- I understand that I am not allowed to have laser hair removal treatments without a written approval from a parent and/or legal guardian if I am under 18 years old.
- I understand it's my sole responsibility to inform my technician about any changes in my current medical conditions prior to any of my laser treatments.
- I acknowledge and accept the risks inherent in the Laser Hair Removal Procedures. I voluntarily assume the risk of possible complications and side effects which may arise from the Laser Treatments set forth herein; and any of my heirs, executors, representatives or assigns hereby release Bared Monkey MedSpa Inc. and all its affiliated companies from any and all claims, liabilities for personal injury, and property damages of any kind sustained while on the premises, during the treatments set forth herein by any employees or representatives of Bared Monkey MedSpa Inc. and all its affiliated companies.
- I certify that I have been informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision of to proceed is based solely on my expressed desire to do so.
- I certify that I am not pregnant and I am not planning to get pregnant during the course of the treatment.
- I certify that I have not taken Accutane within the past six months.
- I certify that I have not taken Anti-biotic within the past four weeks.
- I certify that I do not have a pacemaker or internal defibrillator.
- I confirm that I have read the pre-treatment and post-treatment instructions provided by Bared Monkey MedSpa Inc. and all its affiliated companies and I understand that it's 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 certify that I have read the entire above Informed Consent and believe the Bared Monkey MedSpa Inc. and all its affiliated companies has adequately explained the risks of this therapy, alternative methods of treatment, and possible benefits from this treatment, and I hereby consent to the laser treatment to be performed by the technicians of Bared Monkey MedSpa Inc. and all its affiliated companies. Considering that I have been informed that certain medical conditions and medications prohibit the patient from laser therapy, I have provided a full and truthful medical history and a truthful and accurate account of my medications to this office. Having been apprised of all the above, I have signed this Consent Form and authorize the subject treatment.
November 30, 2022