Client Laser Consent Form

Consent for Pulsed Light and/or Laser-Based Treatment Performed by North East Skin Care Clinic Esthetician.

I authorize North East Skin Care Clinic to perform pulsed light and/or laser treatment on me. I understand that the procedure is purely elective and performed by a licensed aesthetician.

I understand that serious complications are rare but possible. Common side effects include temporary redness and mild “sunburn-like” effects that may last a few hours to 3–4 days or longer. I understand that treatment of benign pigmented lesions and vascular lesions may cause some epidermal damage, which can take 2–4 weeks to resolve.

Pigment changes (light or dark spots on the skin) lasting 1–6 months or longer may occur. Freckles may lighten and/or temporarily or permanently disappear in treated areas. There is a possibility of coincidental hair removal when treating pigmented or vascular lesions in hair-bearing areas.

Other potential risks include blistering, crusting, itching, pain, bruising, skin whitening, burns, infection, scabbing, scarring, swelling, and failure to achieve the desired result. Intense light can cause eye injury and protective eyewear must be worn during treatment.

I understand that sun exposure, use of tanning lamps, self-tanning creams, or not following post-care instructions may increase my chance of complications.

I understand the importance of having an accurate diagnosis by a physician of brown spots prior to treatment, as treatment of an undiagnosed skin cancer may delay proper medical care.

I consent to photographs being taken to evaluate treatment effectiveness, for medical education, training, professional publications, or sales purposes. No photographs revealing my identity will be used without my written consent. If my identity is not revealed, these photographs may be used and displayed publicly without my permission.

The risk of sustaining any type of injury during these procedures results from the nature of the activity and can occur without fault of the aesthetician. By choosing to have this treatment, I accept that I may be injured.

Guarantees

When working on the human body, it is impossible to accurately predict an individual response. You have been quoted the statistical success rate for your procedure; however, factors such as genetics, hormones, and medications can cause each person to respond differently. While we expect a successful outcome based on statistics, it is possible you may have a less optimal response or even no response. When this occurs, it is disappointing for everyone, including us.

Please understand that our fees cover the expense of the machines and products used. Therefore, we are not able to offer refunds or make guarantees.

Before and after treatment instructions have been discussed with me. I have read and understand the attached exclusionary criteria. The procedure, potential benefits, and risks have been explained to my satisfaction. I have had all my questions answered. I understand that by participating in the treatment on this date, I assume all associated risks.