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Laser Hair Removal Consent Form

PLEASE READ CAREFULLY BEFORE YOU SIGN THE WAIVER AND CONSENT TO RECEIVE  LASER HAIR REMOVAL PROCEDURE AT EASE MEDSPA & WELLNESS GROUP.

Laser Hair Removal Procedure:

The purpose of Laser Hair Removal procedure is to diminish or remove unwanted hair, and it generally takes about two to three weeks for the dead hairs to shed out. During the procedure, the hair needs to be in the follicle for the laser to effectively destroy to root, therefore, it is very Important NOT to have wax, tweeze, plucking, thread or electrolysis procedure 4 weeks prior to the laser hair removal Except shaving. The procedure requires more than one treatment and the total number of treatments will vary between individuals. On occasion there are clients that do not respond to treatments. Laser hair removal is not effective on Blonde or Grey hair.

Alternative methods for hair removal are waxing, shaving, electrolysis, and chemical epilation.

Pre & Post Care Instruction:

Pre-treatment care:

  • ​The treatment area needs to be shaved to skin level One Night/Day before appointment.
  • Treatment area needs to be fully washed off and has no makeup, foundation, creams, etc.
  • Must avoid waxing, plucking, threading or electrolysis of the hair for 4 weeks prior to treatment.
  • Avoid the sun exposure for 2-4 weeks prior to treatment.
  • 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.

Post-treatment care:

  • ​Keep the treatment area clean; Use tepid water for bath or shower with gentle wash.
  • Avoid shaving the treated area for at least 4 days after treatment.
  • Do not wax, pluck, thread or use depilatories between laser sessions, only shave if necessary.
  • After treating underarms, do not use deodorants and wait a few hours until any sign of redness has vanished.
  • Avoid sun exposure for at least 3 weeks after treatment. Protect the area with a sunscreen of higher SPF, and protect the skin from developing hyper-pigmentation marks.
  • Avoid any irritating medications or chemicals, such as Retin-A, Benzoyl peroxide, glycolic acid or astringents.
  • After the treatment, the treated area 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.
  • It’s recommended to apply Aloe Vera or Hydrocortisone 1% post-treatment up to 4 times daily for soothing and calming the skin.

Occasionally, unforeseen mechanical problems may occur and your appointment will need to be rescheduled. We will make every effort to notify you prior to your arrival to the spa. Please be understanding if we cause you any inconvenience.

Consent to Perform Laser Hair Reduction

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

  1. There is a risk of scarring.
  2. Short term effects may include but not limited to: reddening, mild burning, temporary bruising,  blistering, or excessive swelling. Hyper-pigmentation (browning) and Hypo-pigmentation (lightening) have also been noted after treatment. These conditions usually resolve within 3-6 months, but permanent color change is a rare risk. Avoiding sun exposure before and after the treatment reduces the risk of color change.
  3. 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.
  4. Bleeding: Pinpoint bleeding is rare but can occur following treatment procedures. Should bleeding occur, additional treatment may be necessary.
  5. Allergic Reactions: In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations have been reported. Systemic reactions (which are more serious) may result from prescription medicines.

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 on easemedspa.com at least 24 hours (48 hours for Full-Body Laser) 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 (48-hours for Full-body) in advance, it will be recorded as a “No Show” in my file. 

I do understand the 24 hours (or 48 hours) Cancelation, Rescheduling and No Show policy; and I agree to pay the appropriate fee: $30-standard services, $50-Full Body laser serviceif I fail to cancel or reschedule 24 hour (or 48-hour) in advance.The same rule applies to No Show appointments. 

Taxes and Gratuities
I understand that Taxes and Gratuity are not included in the cost of the service. Industry standard is 15-20% of the original price, please feel free to extend a gratuity as a result of your experience. Gratuity in Cash or Venmo is always appreciated! I do understand all sales are final and not refundable.  

I acknowledge that 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 understand that immediately following the laser hair removal treatment temporary side effects may occur, including but not limited to: redness, swelling, blistering, burns, itching, discomfort and discoloration (hyper- & hypo-pigmentation), and that scarring, while rare, is also possible. These side effects have been fully explained to my satisfaction. I have had all my questions answered. 

I do understand that laser hair removal is not 100% permanent but a reduction of up to 70-90%. Clinical results may vary depending on skin tone, hormonal levels, hair color, and hereditary influences. Future hormonal changes may cause additional hair growth, and maintenance treatment may be necessary. 

I do understand that tanning during the course of my laser treatments is Not recommended and can cause a number of complications, and I have been informed to avoid sun exposure at least two weeks Before and two weeks After each laser treatment, this also include tanning bed, tanning cream and self tanning. I have been informed to use a sunscreen with SPF on the treated areas during the course of the laser treatments. For optimal results, I should attempt to maintain the same skin tone throughout the treatment process.

I understand that I must Stop waxing, tweezing, bleaching, using depilatories or substance/medication that will damage the hair follicle and could result in less effective treatments. I do understand I need to FULLY SHAVE the treatment areas One Day/NightBefore my appointment. If I fail to shave, either my appointment will be rescheduled or the loss of a session. 

I do understand all appointments have been designed with appropriate time for each client.  Unfortunately that late arrivals will Not receive an extension of scheduled service time, and the client will be responsible for the rescheduling fee if a service appointment is not available at a later time on the same day. I understand that I will expect at least 15-30 minutes waiting time if I arrive late. 

I understand that exposure of my eyes to light could harm my vision. I must keep the eye protection goggles on at all times. 

I confirm that I have not taken Accutane within the last 6 months, and that I do not have a pacemaker or internal defibrillator. 

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. 

By signing this consent form, I understand it is valid for all of my future laser hair removal 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 my questions regarding laser hair removal procedure including the benefits and potential risks, side effects, possible complications associated with laser hair removal and alternative methods have been answered satisfactorily. I understand the laser hair removal procedure 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 laser hair removal procedure performed by any practitioners of Ease Medspa & Wellness Group Inc.

Dated: June 15, 2021

First Client's Name

First Name*

Last Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
First Client's Signature*
Second Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Third Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Fourth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Fifth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Sixth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Seventh Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Eighth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Ninth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
Tenth Client's Name

First Name*

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

Client Questionnaire

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
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

Previous hair removal methods
shaving
tweezing
waxing
depilatories
electrolysis
laser
Do you have a suntan?*
No
Yes
Skin Tone: (Please select one to better determine the procedure settings)*

If Other, please list:
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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