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Laser Hair Removal Informed Consent Form

General

  • Laser hair removal only works on the hairs that are in the active stage of growing. Laser hair removal does not work on dormant hairs that have already detached from the follicle. For this reason, complete destruction of all hair follicles in a single treatment is not possible. This also means that each hair removal session may produce different results.
  • We recommend 6-15 treatments for at least a 90% reduction in hair growth, but individual results will vary depending on your skin type, natural hair color, density of the hair, amount of hair in the treated area, etc.
  • Every individual's goals and current condition will vary. Laser hair removal is not an exact science, and Pure Cosmetics cannot prescribe an exact number of treatments to achieve the desired results. Therefore, we cannot guarantee that the patient will achieve the desired results.
  • Any laser hair removal is not 100% permanent throughout an individual's life. You may need touchups after completing your full package, as hair growth is largely regulated by hormonal changes.
  • Patients can expect that the hair will grow back finer, slower or in "patches" within the first several treatments.

Pre-Care Instructions

  • Patients must avoid self-tanner and sun/tanning bed exposure to the areas to be treated for a minimum of 4 weeks prior to your appointment.
  • Patients must shave the entire area to be treated 1-2 days prior to their appointment. If unable, our technicians can shave the area for a $15 shave fee.
  • Patients must avoid waxing, tweezing, depilatory creams to keep the hair follicle intact during the term of their laser hair removal treatments. Performing any of the aforementioined methods of hair removal will greatly decrease the efficacy of laser hair removal treatments.
  • Most antibiotics increase photosensitivity, which makes it dangerous for a patient to undergo laser hair removal. If you have been on antibiotics in the past two weeks, or have any changes to your medication or history, notify Pure Cosmetics immediately.

Post Care Instructions

  • Raised follicles may be present immediately after your laser hair removal treatment. This is normal and should subside within the first few hours to the first few days, depending on the sensitivity of your skin. Avoid scratching, picking or exfoliating, as this will further irritate the skin.
  • Patients should avoid self-tanner, sun or tanning bed exposure for a minimum of 3 days after your appointment to minimize potential hypo- or hyper-pigmentation.
  • Patients may see what appears to be hair growth after a laser hair removal treatment. This is normal and is the shedding of the hair that was under the skin. 
  • Notify Pure Cosmetics immediately if you appear to have an adverse reaction, or irritation that lasts more than 2 days.

Potential Risks:

I am aware of the following possible experiences/risks with laser hair removal:

  • DISCOMFORT: some discomfort may be experienced during laser treatment.
  • WOUND HEALING: laser hair removal can result in swelling, blistering, crusting or flaking of the treated areas, which may require one to three weeks to heal. Once the surface is healed, it may be pink or sensitive to the sun for an additional 2-4 weeks, or longer for some patients.
  • BRUISING/SWELLING/INFECTION: With some lasers, bruising of the treated area may occur. Additionally, there may be some swelling noted. Finally, skin infection is a possibility although, rare, whenever a skin procedure is formed.
  • PIGMENT CHANGES: During the healing process, there is a slight possibility that the treated area can become either light or darker in color compared to the surrounding skin. This is usually temporary, but on rare occasion, may become permanent.
  • SCARRING: Scarring is a rare occurrence, but it is a possibility when the skin’s surface is disrupted. To minimized the chance of scarring, it is IMPORTANT that you follow all pre- and post-treatment instructions carefully.
  • EYE EXPOSURE: Protective eyewear will be provided. It is important to keep these on at all times during the treatment in order to protect your eyes from laser exposure.

I hereby authorize and direct any associates or assistants of Pure Cosmetics, PLLC. to perform laser assisted hair removal on me. I understand that I will require several treatments to obtain significant, long-term reduction of hair growth. I also understand some people may not experience complete hair loss even with multiple laser procedures, therefore Pure Cosmetics cannot guarantee a patient that he or she will achieve the desired results, even after completion of the recommended number of treatments.

By signing below, I certify that I have read and fully understand the contents of this consent form for laser hair removal treatment with Pure Cosmetics, PLLC., and that all disclosures referred to herein were made me to me.

First Patient's Name

First Name*

Last Name*
First Patient's Date of Birth*
First Patient's Signature*
Second Patient's Name

First Name*

Last Name*
Second Patient's Date of Birth*
Third Patient's Name

First Name*

Last Name*
Third Patient's Date of Birth*
Fourth Patient's Name

First Name*

Last Name*
Fourth Patient's Date of Birth*
Fifth Patient's Name

First Name*

Last Name*
Fifth Patient's Date of Birth*
Sixth Patient's Name

First Name*

Last Name*
Sixth Patient's Date of Birth*
Seventh Patient's Name

First Name*

Last Name*
Seventh Patient's Date of Birth*
Eighth Patient's Name

First Name*

Last Name*
Eighth Patient's Date of Birth*
Ninth Patient's Name

First Name*

Last Name*
Ninth Patient's Date of Birth*
Tenth Patient's Name

First Name*

Last Name*
Tenth Patient's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
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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