SECTION 1: MEDICAL INFORMATION
Absolute Contraindications :
Accutane or other similar medication
Autoimmune disease, HIV, lupus, hepatitis, scleroderma
Active infection in the treatment area
Melanoma or lesions suspected of malignancy
Breastfeeding (medical-legal, may increase skin sensitivity & likelihood of PIH Epilepsy contraindicated for LED light therapy
SECTION 2: CLIENT CONSENT FORM
(initial each acknowledgment line below)
I acknowledge that my skin might experience temporary irritation, tightness, or redness, which usually dissipates within 72 hours depending on skin sensitivity.
I acknowledge that if I fail to use a minimal sunscreen (SPF 30) and follow the direction for use, I am more susceptible to sunburn, sun damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.
I have disclosed my history of allergies above and I acknowledge that I may experience an allergic reaction.
I hereby agree to have the treatment performed and agree to follow all pre-and post-treatment instructions.
I acknowledge that I should avoid use of aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre- and post-treatment.
I acknowledge that I have answered all questions truthfully and completely.
I acknowledge that I should avoid use of Retin-A type products for a period of time recommended by my physician and /or skincare practitioner per and post the treatment.
By signing below, I certify that I have read and fully understood the contents of this consent form, and that the information I provided above are complete, accurate, and up-to-date to my knowledge.
I also understand that any appointment that I make that is not cancelled within 48 hours I will be charged a ($50 or forfeiture of one of the treatment) no show fee