Consent to Perform Laser Hair Reduction
Guest name: Date (mm/dd/yyyy):
I understand that the service(s) requested to be performed on me by Deify Laser + Beauty Lounge Inc. is(are) purely elective and that:
- There are potential side effects, including but not limited to: Discomfort, change in pigmentation, scarring, bruising, burns or excessive swelling.
- I understand that tattoos and permanent makeup in the treatment area may be altered and moles may be lightened.
- I understand that recurrent viral infections such as herpes simplex (cold sores) or varicella (shingles) may be activated
- Eye injury is possible but unlikely, providing complete eye protection is properly used throughout laser treatment sessions.
- I understand that a single procedure will most likely fail to completely remove all my unwanted hair in the area treated. Multiple treatments are required. Individual response will vary according to skin types, hair color, degree of tanning, follow up care, and the body area being treated.
- Unprotected sun exposure in the weeks following treatments is contraindicated as it may cause or worsen this condition.
I acknowledge that pre-service and post-service instructions have been discussed with me and that I understand all such instructions. The elected service specified above, as well as alternative service options and the potential benefits and risks of each have been explained to my satisfaction. I have had all my questions answered.
I understand the requested and specified service(s) and accept the risks. I hereby release Deify Laser + Beauty Lounge Inc. from any and all injuries, actions, causes of action, suits, damages, judgments, claims, and demands whatsoever, in law or equity, which I shall or may have, for, upon, or by reason of the performance or non-performance of the above indicated services.
I have read and understood all information presented to me before signing this consent form.
Legal Signature of Adult Participant or Parent/Guardian if a minor