INFORMED CONSENT LASER HAIR REMOVAL

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "INFORMED CONSENT LASER HAIR REMOVAL"

Transcription

1 INFORMED CONSENT LASER HAIR REMOVAL 1. Informed Consent. The purpose of this Informed Consent is to help you decide whether a laser hair removal ( LHR ) cosmetic procedure is right for you and to help you make an informed decision to undergo this procedure. This Informed Consent gives you general information about LHR cosmetic procedures, explains other treatment options, and identifies the benefits, risks, side effects and possible complications associated with LHR procedure. 2. Laser Hair Removal Procedure. LHR is a non-invasive laser treatment designed to remove unwanted hair from all parts of the body. The laser device works by emitting pulses of light energy that penetrate the skin and destroy hair follicles while the device s handpiece cools the surrounding skin. Because the laser needs to fill the hair follicle to work effectively, it is important not to wax, tweeze, have electrolysis procedures or pluck hair for 4 weeks prior to the procedure. You will be required to wear protective eye glasses during the procedure to protect your eyes from the laser light. You may feel a slight burning, stinging or pinching sensation during the procedure. Treatment of dark course hair generally achieves the best results while removal of light fine hair generally requires additional treatments which may or may not be successful. Clinical results of LHR may also vary depending on individual skin type, hormonal levels and hereditary influences. Therefore, some patients may experience partial results and some may notice no improvement at all. Future hormonal changes may cause additional hair growth. LHR procedure generally involves a series of treatments. Ideal (light skin/dark hair) candidates can usually achieve 70%-90% reduction with a series of 6 treatments. Thicker skinned areas such as men s backs, faces or neck usually require more than 6 sessions and usually achieve only partial reduction or hair thinning. 3. Alternative Procedures. LHR is a voluntary cosmetic procedure which is not necessary or required. 4. Not Good Candidates. Generally you are not a good candidate for LHR procedure if you are pregnant, nursing or plan to become pregnant while undergoing LHR treatments. Individuals who have used Accutane within the past six months or who used any medications requiring limited exposure to sunlight are not good candidates for LHR procedure. Individuals with recently tanned skin are advised to delay undergoing the LHR procedure. The laser may not be effective on blond or gray hair. Sun exposure 4 weeks prior to treatment may reduce effectiveness of the laser. It is important to shave the area prior to treatment session. (We do not

2 provide shaving services as you must do this yourself prior to the treatment). Please inform us if you have any medical allergies. 5. Risks and Complications. All medical and cosmetic procedures are associated with certain risks and may result in complications. Possible risks and complications associated with LHR procedure include: Temporary reddening, burning, swelling, bruising or discoloration of the skin over the treated area. Blistering, scarring, activation of cold sores, infection or permanent discoloration, which may occur in rare cases. Please inform us if you have ever had a problem with cold sores. Folliculitis, which is an infection of the hair follicle, which may take several days to resolve. Hyperpigmentation (darkening of the skin) or hypopigmentation (lightening of the skin), which rare may take several months to fully resolve. Crusting or blistering of the area exposed to laser, which is rare and which may take several days to heal. As with all LHR procedures, some re-growth of hair may occur after treatment sessions are completed. 6. Post Procedure Instructions. It is IMPORTANT that you follow all post-treatment instructions carefully because during the healing process, there is a slight possibility that the treated area can become either lighter (hypo-pigmentation) or darken (hyper-pigmentation) in color compared to the surrounding skin. This is usually a temporary condition; however, on a rare occasion, it can be permanent. Laser-treated area should not be exposed to sun or tanning beds. Please call your doctor promptly if complications develop after the procedure. By signing this Informed Consent, you understand and agree as follows: I have been given opportunities to ask questions about the treatment procedure(s) and all of my questions have been answered satisfactorily. I understand that no guarantees have been made to me regarding the outcome of laser hair removal and I hereby release Bared Monkey Inc. and the technicians of Bared Monkey Inc. from all liabilities associated with the above indicated procedure. I understand there are several alternative treatments to laser therapy. These include electrolysis, tweezing, waxing and shaving.

3 I understand that immediately following the laser treatment temporary side effects may occur, including but not limited to: redness, swelling, blistering, burns, itching, discomfort and discoloration (hyper- and hypo-pigmentation), and that scarring, while rare, is also possible. I agree to notify Bared Monkey Inc. of any of these side effects occur. I understand and agree that Bared Monkey Inc. may choose to take photos of my treatment area for the purpose of monitoring my progress. I understand that once I have started my treatment program there are no refunds. I confirm that I have received the post treatment instructions provided by Bared Monkey Inc. and I understand that it s my responsibility to follow these instructions, and that my failure to adhere to these recommendations may results in complications and contraindications for which I am fully responsible. I understand that this consent form is valid for all future laser hair removal treatments performed, and I will alert the staff if there are any changes to my medical history, or if I become pregnant. I have read the entire above Informed Consent and believe the Bared Monkey Inc. has adequately explained the risks of this therapy, alternative methods of treatment, and possible benefits form this treatment, and I hereby consent to the laser treatment to be performed by the technicians of Bared Monkey Inc. Considering that I have been informed that certain medical conditions and medications prohibit the patient from laser therapy, I have provided a full and truthful medical history and a truthful and accurate account of my medications to this office. Having been apprised of all the above, I have signed this Consent Form and authorize the subject treatment. Name Print: Signature: Date: Witness: Date: (Parent or Guardian if patient is under 18)

4 Laser Hair Removal Before And After Treatment Pre LHR Treatment Instruction: The area to be treated should be shaved the day before your treatment. NO Tanning (self-tanner, tanning bed, etc.) 4 weeks prior to treatment. NO plucking, waxing, using a depilatory or undergo electrolysis in the areas you wish to have treated 4 weeks prior to treatment. Shaving is the fine. NO Accutane 6 months prior to treatment. NO make-up, lotion, body oil, perfume and jewelry prior to your appointment. If you have a history of Herpes Simplex Virus or cold sores, you must pre-medicate one day prior to treatment to prevent further outbreaks. Please inform your technician of all current/changes to your medications four (4) weeks prior to your scheduled treatment. Certain medications may cause your skin to be more sensitive to both sunlight and laser light. For your safety, we need to be aware of any medications you are presently taking. Post LHR Treatment Instruction: Some redness and swelling around the treated area is normal after treatment and may feel similar to a sunburn. This should resolve within several hours to several days after treatment. Applying ice packs or cool compresses will help with any discomfort. NO exercising or working out for a minimum 12 hours until the redness has subsided. NO saunas, hot tubs, or hot showers for a minimum 12 hours until the redness has subsided. NO irritants (glycolics, acids, retinoids, etc.) for 7 days after treatment. NO real suntan or use solariums for the entire duration of course of treatments and for 1 month after the final treatment. NO plucking, waxing, using a depilatory or undergo electrolysis in between treatments. If needed, the only other acceptable hair removal method is shaving. Apply sunscreen daily. It should be at least SPF 30 protects UVA/UVB and contains the physical blockers zinc oxide and titanium oxide. It may take 1-3 weeks for the dead hairs to shed out of the follicles. It s recommended that you gently exfoliate the treated area about 7 days after your treatment, 2-3 times a week. Apply moisturizer after exfoliating to help skin replenish. If you have any questions or problems please call us at (212)

5 Bared Monkey Laser Spa Laser Hair Removal and/or Laser Skin Rejuvenation Medical History and Skin Type Form Date: Patient Name: Date of Birth: Address: City: State: Zip: Telephone: Emergency contact name and phone: Please specify your genetic origin: African American Asian Caucasian Hispanic Mediterranean Middle Eastern Native American Other Females: Are you pregnant? Are you breastfeeding? Are you planning pregnancy during the course of your treatments? During any past pregnancy, did you develop hyperpigmentation or masking? Do you have regular periods? All patients: Medical History--Please check all that apply AIDS Albinism Acne Bleeding disorders Botox Diabetes HIV Hirsutism Hormone Replacement Implants Kaposi s sarcoma Keloid scars Porphyria Pacemaker Permanent makeup Rosacea Seizures/Epliepsy Skin cancer Endocrine disorders Lesions/Sores/Open wounds Severe histamine reactions Epidermolysis bullosa Lupus erythematosus Skin Marks/ Molds/ Freckles Heart disease PCOS Sunburn Hemorrhoids Port-wine stain Tattoos Herpes 1&2 Precocious puberty Vitiligo High blood pressure Psoriasis/Eczema Others Gold Theraphy Are you currently being treated for any skin condition? If yes, please explain Do you have a history of bleeding coagulopathies or use of anticoagulopathies? Do you have any active skin diseases or infection in the area to be treated? If yes, please descript Do you have any skin allergies? If yes, please descript Have you had skin cancer or precancerous lesions? If yes, please descript Are there any moles with hair in the area to be treated? Are you allergic to latex, lidocaine, or any lotions? If yes, please descript Have you had any surgery in the area to be treated? If yes, please descript Have you had any prior laser treatments or other skin treatments in the area to be treated? (i.e. Cosmeceuticals/ Chemical peels/ Botox/ Laser Resurfacing etc.) Have you/are you using Accutane? Date of last use: Are you using Retin-A, Renova, Differin, or Tazorac? Date of last use: Are you using glycolic/aha home care products? Date of last use: Are you undertaking a course of treatment that may make your skin photosensitive? (See attached sheet for information and a list of common drugs) If yes, please descript Have you had exposure to sun or artificial tanning during the 3-4 weeks prior to treatment? Do you use facial depilatories (hair removal lotions)? Date of last use

6 Skin Typing NAME DATE Please answer the following questions by circling the number which best describes you. Your clinician will total the score during the consultation. My ethnic origin is closest to: I. Very fair (Celtic and Scandinavian) (check one) II. Fair-skinned Caucasians with light hair and light eyes III. Pale-skinned Caucasians with dark hair and dark eyes IV. Olive-skinned (Mediterranean, some Asian, some Hispanic) V. Dark-skinned (Middle Eastern, Hispanic, Asians, some Africans) VI. Very dark-skinned (African) My eye color is: Light blue 0 Blue/green 1 Green/gray/golden 2 Hazel/light brown 3 Brown 4 My natural hair color at age 18 was: The color of my skin that is not normally exposed to sun is: If I go out into the sun for an hour or so without sunscreen and have not been out in the sun for weeks, my skin will: When was the last time the area to be treated was exposed to natural sunlight, tanning booths or artificial tanning cream? Red 0 Blonde 1 Light brown 2 Dark brown 3 Black 4 Pink to reddish 0 Very pale 1 Pale with a beige tint 2 Light brown 3 Medium to dark brown 4 Dark brown-black 6 Burn, blister and peel 0 Burn, then when the burn resolves there is little or no color change 1 Burn, but then turns to tan in a few days 2 Get pink, but then turns to tan quickly 3 Just tan 4 Just gets darker 5 My skin color is so dark I can t tell 6 Longer than one month ago 0 Within the past month 1 Within the past two weeks 3 Within the past week 4 Total Score: If your score is: Your skin type is: Notes: 0 3 I 4 7 II 8 11 III IV V VI

7 List all current Medications you are taking: Please indicate which of the following concerns you have regarding your skin? Aging Sun damage Rosacea Age spots Acne Enlarged pores Blackheads Texture Redness Wrinkles Whiteheads Other Leg veins Hair removal Oily skin Spider veins Unevenness Dry skin Scarring Hyperpigmentation Sensitive skin Please specify which areas you would like to consider for laser hair removal? Note: I certified the information is true and correct. I am aware that it is my responsibility to inform the technicians of Bared Monkey Inc. my current medical and health conditions and to update this history is essential for the caregiver to execute the appropriate treatment procedures. Signature Date

INDY LASER CLIENT INFORMATION

INDY LASER CLIENT INFORMATION 172 W. Carmel Drive Carmel, IN 46032 Tel: (317)575-2737 INDY LASER CLIENT INFORMATION Client Name Address City Zip Code Mobile Phone Home Phone Date of Birth Body Hair Color Email Address Referral Source

More information

NEHSNORTH EASTERN HEALTH SPECIALISTS

NEHSNORTH EASTERN HEALTH SPECIALISTS COSMETIC DERMATOLOGY NEHSNORTH EASTERN HEALTH SPECIALISTS nehs.com.au CONSENT FORM ACNE Treatment I, DOB:, of authorize of North Eastern Health Specialist to perform hair removal with the BBL / Nd-Yag

More information

Consent for Laser/Light Based Treatment

Consent for Laser/Light Based Treatment Consent for Laser/Light Based Treatment I authorize Dr. Linda Cook to oversee laser/intense pulsed light cosmetic dermatology treatments on me, including but not limited to deep tissue heating, soft tissue

More information

Welcome to Bella! Give the Gift of Bella. A few tips to prepare you for your first visit: Gift Certificates are just $100 for a $150 value!

Welcome to Bella! Give the Gift of Bella. A few tips to prepare you for your first visit: Gift Certificates are just $100 for a $150 value! Welcome to Bella! We are glad to have you as our guest. We encourage you to visit our website to see all of the exciting new laser and skincare treatments that we offer. Please be aware of our 24 hour

More information

IPL: Photo Rejuvenation Photo-rejuvenation information

IPL: Photo Rejuvenation Photo-rejuvenation information IPL: Photo Rejuvenation Photo-rejuvenation information Treatment of benign pigmented lesions generally requires 5-6 treatments performed approximately every 3-4 weeks or once all the darkened cells have

More information

COSMETIC LASER AND AESTHETICS CENTER

COSMETIC LASER AND AESTHETICS CENTER COSMETC LASER AND AESTHETCS CENTER LGHT SHEAR LASER HAR REMOVAL NFORMATON AND CONSENT understand that the purpose of this procedure is to reduce and/or remove unwanted hair. There are several alternatives

More information

Skin Care History Questionaire and Waiver

Skin Care History Questionaire and Waiver Skin Care History Questionaire and Waiver Please answer the following questions so that your Skin Care Specialist may have a better understanding of your general health and lifestyle, thereby enabling

More information

ICON PRE AND POST OP INSTRUCTIONS. MAXG or 1540 (XD/XF)

ICON PRE AND POST OP INSTRUCTIONS. MAXG or 1540 (XD/XF) ICON PRE AND POST OP INSTRUCTIONS MAXG or 1540 (XD/XF) Pre-Op Instructions 1. Please arrive to appointment 15 minutes before your scheduled time. Please be advised, running late may result in less than

More information

Informed Consent For Laser Hair Removal

Informed Consent For Laser Hair Removal Informed Consent For Laser Hair Removal INSTRUCTIONS This informed-consent document has been prepared to help inform you about laser procedures, its risks, as well as alternative treatment(s). It is important

More information

Patient Information and Consent for Medical/Laser/Intense Pulsed Light Treatment. VASClinic PROCEDURES

Patient Information and Consent for Medical/Laser/Intense Pulsed Light Treatment. VASClinic PROCEDURES This consent form includes general descriptions of various dermatological treatments, including possible benefits and risks that may occur as a result of these treatments. Your doctor or nurse will describe

More information

POST-TREATMENT INSTRUCTIONS FOR IPL TREATMENTS

POST-TREATMENT INSTRUCTIONS FOR IPL TREATMENTS POST-TREATMENT INSTRUCTIONS FOR IPL TREATMENTS General A mild sunburn-like sensation is expected. This usually lasts 2 to 24 hours but can persist up to 72 hours. A mild swelling and/or redness may accompany

More information

Welcome to Patient Registration Form

Welcome to Patient Registration Form Welcome to Patient Registration Form Patient Information: Patient/Child First Name: MI: Last Name: Age: Date of Birth: Occupation: Ethnicity: Hispanic Not Hispanic Unknown Language: English Spanish Other

More information

What are spider veins? What is the best treatment for spider veins?

What are spider veins? What is the best treatment for spider veins? Laser Spider/Leg Vein Q & A What are spider veins? Millions of women and men are bothered by unsightly spider veins on their faces and legs. Spider veins or telangiectasias are those small red, blue and

More information

CONTRAINDICATIONS FOR IPL/LASER TREATMENTS

CONTRAINDICATIONS FOR IPL/LASER TREATMENTS CONTRAINDICATIONS FOR IPL/LASER TREATMENTS Permanent Contraindications: You will unfortunately not be able to HAVE the treatment if any of the below apply: Vitiligo Diabetes Porphyria Dark - Black Skin

More information

There are different types of lasers that according the wavelength of their beams have different indications; the most common ones used on skin are:

There are different types of lasers that according the wavelength of their beams have different indications; the most common ones used on skin are: What is Laser Surgery? Laser (Light Amplification by Stimulated Emission of Radiation) surgery uses a very hot, focused beam of light to remove or cauterise a skin lesion and control bleeding without affecting

More information

Save Face Laser & IPL Fact Sheet

Save Face Laser & IPL Fact Sheet Save Face Laser & IPL Fact Sheet Patient information Laser & IPL (Intensed Pulse light) What is laser & IPL (Intensed Pulse light)? Over the last decade the use of light such as Lasers and Intense Pulsed

More information

HIRSUTISM. What are the aims of this leaflet?

HIRSUTISM. What are the aims of this leaflet? HIRSUTISM What are the aims of this leaflet? This leaflet has been written to help you understand more about hirsutism. It tells you what it is, what causes it, what can be done about it, and provides

More information

Treatment Guidelines

Treatment Guidelines Treatment Guidelines Cutera Inc. World Headquarters 3240 Bayshore Boulevard, Brisbane, CA 94005 USA Tel: +1 415 657 5500 Fax: +1 415 330 2444 www.cutera.com 1 The Cutera, Inc. Prowave LX handpiece is indicated

More information

Informed Consent for Cosmetic Laser Skin Resurfacing with the DOT laser

Informed Consent for Cosmetic Laser Skin Resurfacing with the DOT laser Informed Consent for Cosmetic Laser Skin Resurfacing with the DOT laser INSTRUCTIONS This informed-consent document has been prepared to help inform you about laser procedure, its risks, as well as alternative

More information

FRAXEL TREATMENT GUIDELINES By Shaun Patel, M.D.

FRAXEL TREATMENT GUIDELINES By Shaun Patel, M.D. FRAXEL TREATMENT GUIDELINES By Shaun Patel, M.D. Fraxel is a laser skin resurfacing procedure that provides for a safe, effective and noninvasive way to treat hyperpigmentation, sun-damage, fine lines,

More information

Profractional Laser Resurfacing.

Profractional Laser Resurfacing. Profractional Laser Resurfacing. Profractional laser is a new procedure that can dramatically improve the texture of the skin with minimal downtime. It can smooth out acne scars, improve pigmentation problems

More information

medical history for Vectus laser treatment

medical history for Vectus laser treatment medical history for Vectus laser treatment PATIET IFORMATIO PLEASE PRIT LAST AME FIRST AME OF BIRTH SEX MALE FEMALE STREET ADDRESS CIT STATE ZIP PHOE UMBERS HOME WORK CELL Which is your primary / preferred

More information

BBLs BroadBand Light. Daryl Mossburg, RN BSN Clinical Specialist Sciton, Inc. All rights reserved.

BBLs BroadBand Light. Daryl Mossburg, RN BSN Clinical Specialist Sciton, Inc. All rights reserved. BBLs BroadBand Light Daryl Mossburg, RN BSN Clinical Specialist 1 2009 Sciton, Inc. All rights reserved. BBL - BroadBand Light BBL module incorporated into JOULE BBLs Standalone System 2 2009 Sciton, Inc.

More information

Love the Skin You re In. Emily Lambert, MD Sara Drew, ANP

Love the Skin You re In. Emily Lambert, MD Sara Drew, ANP Love the Skin You re In Emily Lambert, MD Sara Drew, ANP Conditions Treated Unwanted Hair Sun Spots Wrinkles Redness Blood Vessels Spider Veins Scarring Aging Skin Melasma pregnancy mask Sun-damage Pre-cancers

More information

SANTA ANA SKIN CARE CLINIC 683-B HARKLE RD SANTA FE, N.M. 87505

SANTA ANA SKIN CARE CLINIC 683-B HARKLE RD SANTA FE, N.M. 87505 SANTA ANA SKIN CARE CLINIC 683-B HARKLE RD SANTA FE, N.M. 87505 FIRST NAME: LAST NAME: DATE OF BIRTH: / / MAILING ADDRESS: CITY: STATE: ZIP: WORK #: HOME #: SS#: WHO REFERRED YOU TO OUR OFFICE? Thank you

More information

Radiation Therapy and Caring for Your Skin

Radiation Therapy and Caring for Your Skin Patient Information Radiation Therapy and Caring for Your Skin Comments, Feedback? Contact Patient and Professional Education 519-685-8742 Email: lrcpeducation@lhsc.on.ca Reviewed by the LRCP Patient Education

More information

Patented Technology White, Blonde, Red & Gray Hair Removal. Photo-Tenseur and Anti-Ageing Treatment

Patented Technology White, Blonde, Red & Gray Hair Removal. Photo-Tenseur and Anti-Ageing Treatment Patented Technology White, Blonde, Red & Grey Hair Removal Client Consent Form Photo Rejuvenation FIRST NAME: Photo-Tenseur and Anti-Ageing Treatment SURNAME: DATE: GENDER: D.O.B. / / ADDRESS: PHONE: (H)

More information

Plot 1322 Shehu Yaradua Blvd. Mabushi District, Abuja

Plot 1322 Shehu Yaradua Blvd. Mabushi District, Abuja Plot 1322 Shehu Yaradua Blvd. Mabushi District, Abuja At, we believe that taking care and pampering yourself should not be a special luxury. We feel it is a necessity. Our expert services and professional

More information

A Free Guide to different Hair Removal Treatments

A Free Guide to different Hair Removal Treatments A Free Guide to different Hair Removal Treatments 2 Introduction From peach-fuzz to long, dark, or coarse growth, both men and women have been doing battle with excess hair -and hair removal - for centuries.

More information

Laser hair removal. Birmingham Regional Skin Laser Centre

Laser hair removal. Birmingham Regional Skin Laser Centre What is laser hair removal? involves removing unwanted hair using laser. The high level of energy in the laser is taken up by the pigment within the hair (melanin), which converts the energy into heat

More information

Laser Patient Instructions

Laser Patient Instructions Laser Patient Instructions DER MICROLASERPEEL PATIENT INSTRUCTIONS (31010) MicroLaserPeel (MLP ) Patient response can vary after a MLP treatment. Most people have redness and some have swelling within

More information

Laser treatment for the removal of unwanted Hair

Laser treatment for the removal of unwanted Hair Laser treatment for the removal of unwanted Hair Exceptional healthcare, personally delivered Welcome to the Bristol Laser Centre We are part of the Plastic Surgery Department at North Bristol NHS Trust

More information

Client Consent: EYELASH EXTENSIONS

Client Consent: EYELASH EXTENSIONS Thank you for choosing Blush Aesthetics Studio, We look forward to a long & lengthy lash affair. So, From the start we are completely honest & transparent. Because of the nature of this service There are

More information

Laser Tattoo Removals Frequently Asked Questions

Laser Tattoo Removals Frequently Asked Questions Laser Tattoo Removals Frequently Asked Questions What type of laser do you use? We use a Sapphire and Ruby Q-switched KTP/ YAG laser, this type of laser delivers the energy quickly and allows for the best

More information

What are the alternatives?

What are the alternatives? Aesthetic Extender Symposium 2013 Laser Hair Removal David Ciocon, MD Staff Associate, Skin Laser & Surgery Specialists of NY & NJ Director of Procedural Dermatology & Dermatologic Surgery Director of

More information

INFORMED-CONSENT- LASER RESURFACING PROCEDURES OF SKIN

INFORMED-CONSENT- LASER RESURFACING PROCEDURES OF SKIN INFORMED-CONSENT- LASER RESURFACING PROCEDURES OF SKIN 2000 American Society of Plastic Surgeons. Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained

More information

PATIENT DEMOGRAPHICS SHEET

PATIENT DEMOGRAPHICS SHEET PATIENT DEMOGRAPHICS SHEET Patient Name: Parent/Legal Guardian Name: Date of Birth: Phone: Address: CITY STATE ZIP Social Security Number: Patient Phone: Sex: M F Home Cell Business Okay to leave detailed

More information

CONSENT FOR HALO LASER TREATMENT

CONSENT FOR HALO LASER TREATMENT CONSENT FOR HALO LASER TREATMENT I authorize Dr. Stacey Folk, Dr. Michael Bateman or a designated practitioner to perform a Halo Pro fractional laser treatment on the following area(s) of my body: The

More information

Patient consent form: Vascular Blemishes Please read and fill in all 7 pages

Patient consent form: Vascular Blemishes Please read and fill in all 7 pages Patient consent form: Vascular Blemishes Please read and fill in all 7 pages No medical technique is perfect and no two people are alike. Accordingly, the treatment of vascular blemishes ("broken capillaries"

More information

Esthetician Services

Esthetician Services Cosmestic Surgery 3333 Mendocino Avenue, Suite 130 Santa Rosa, CA. 95403 Esthetician Services Kaiser Permanente offers a range of cosmetic skin care treatments customized for the specific needs of your

More information

The Smart Patient's TM guide from DR. ROBERTUS. Laser & Cosmetic Clinic. If You Dream It, We Can Help You Achieve It.

The Smart Patient's TM guide from DR. ROBERTUS. Laser & Cosmetic Clinic. If You Dream It, We Can Help You Achieve It. 10 THINGS YOU SHOULD KNOW ABOUT LASER HAIR REMOVAL The Smart Patient's TM guide from DR. ROBERTUS Laser & Cosmetic Clinic If You Dream It, We Can Help You Achieve It. www.robertusmd.com 9651 Yonge St.

More information

Choosing Your Skin Care Routine with Mene & Moy

Choosing Your Skin Care Routine with Mene & Moy Choosing Your Skin Care Routine with Mene & Moy This is not intended, nor is it, a comprehensive regieme to cover all the Mene and Moy products. Indeed, some of the products mentioned here are form other

More information

Laser Hair Removal Frequently Asked Questions

Laser Hair Removal Frequently Asked Questions Laser Hair Removal Frequently Asked Questions Q: What does laser hair removal feel like? Is it painful? A: Most people with lighter skin should feel no pain as they will undergo laser hair removal with

More information

Chemical skin peels and other skin treatment procedures are not an alternative to skin tightening surgery when indicated.

Chemical skin peels and other skin treatment procedures are not an alternative to skin tightening surgery when indicated. INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about chemical skin peel and skin treatment procedure(s), its risks, and alternative treatment. It is important

More information

INFORMED CONSENT- CO 2 LASER TREATMENT PROCEDURES OF SKIN

INFORMED CONSENT- CO 2 LASER TREATMENT PROCEDURES OF SKIN INFORMED CONSENT- CO 2 LASER TREATMENT PROCEDURES OF SKIN INSTRUCTIONS This is an informed consent document which has been prepared to help inform you about carbon dioxide (CO 2 ) laser treatment procedures

More information

S C L E R O T H E R A P Y

S C L E R O T H E R A P Y S C L E R O T H E R A P Y Southern Arizona Laser & Vein Institute (SALVI) can eliminate unsightly spider veins in just a few easy treatments, leaving your legs virtually clear and free from the appearance

More information

PROFESSIONAL REVITALIZING PEEL (15% mandelic acid/15% lactic acid) PROFESSIONAL REVITALIZING PEEL (22.5% mandelic acid/22.

PROFESSIONAL REVITALIZING PEEL (15% mandelic acid/15% lactic acid) PROFESSIONAL REVITALIZING PEEL (22.5% mandelic acid/22. PROFESSIONAL REVITALIZING PEEL (15% mandelic acid/15% lactic acid) PROFESSIONAL REVITALIZING PEEL (22.5% mandelic acid/22.5% lactic acid) PROFESSIONAL REVITALIZING PEEL (30% mandelic acid/30% lactic acid)

More information

Laser Tattoo Removal. Birmingham Regional Skin Laser Centre

Laser Tattoo Removal. Birmingham Regional Skin Laser Centre What is laser tattoo removal? Laser tattoo removal is a treatment to help fade and remove unwanted tattoos. We are able to remove the following types of tattoos: Amateur tattoos - normally formed using

More information

Name: Date: Occupation: Address: Phone: Date of Birth: City: State: Zip Code: Cell: Phone: Contact me by Text Cell Emergency Contact:

Name: Date: Occupation: Address: Phone: Date of Birth: City: State: Zip Code:   Cell: Phone: Contact me by Text Cell Emergency Contact: Name: Date: Occupation: Address: Phone: Date of Birth: City: State: Zip Code: Email: Cell: Phone: Contact me by Text Cell Emergency Contact: How did you hear about us: Referral Name: General Health 1.

More information

May Is National Melanoma/Skin Cancer Detection and Prevention Month

May Is National Melanoma/Skin Cancer Detection and Prevention Month May Is National Melanoma/Skin Cancer Detection and Prevention Month What is Melanoma? Melanoma is a type of skin cancer. It begins in the cells of the skin called melanocytes. To understand melanoma, it

More information

Intense Pulsed Light IPL

Intense Pulsed Light IPL Intense Pulsed Light SKINBASE IPL MEDICAL THERAPIES Intense Pulsed Light IPL IPL is a light based therapy that works by targeting structures within the skin such as; melanin, blood, and water in collagen,

More information

Chapter 8: Skin Disorders and Diseases

Chapter 8: Skin Disorders and Diseases Chapter 8: Skin Disorders and Diseases Why study skin disorders and diseases? (p. 177) A cosmetologist needs to understand the underlying structure of the skin and common skin problems because you should

More information

before it starts getting better. Do not give up! We will continue to work with you to get your acne better.

before it starts getting better. Do not give up! We will continue to work with you to get your acne better. ACNE Acne is a common condition in teenagers and adults. It affects up to 80-90% of teenagers. Developing an acne bump is multifactorial, meaning that several processes lead to the formation of the acne

More information

The Hair Removal ebook!

The Hair Removal ebook! The Hair Removal ebook! Brought to you by Terms of Use: This ebook was created to provide educational information regarding hair removal. Before making any decision, please consult a qualified health or

More information

ONE LASER FOR EVERYONE

ONE LASER FOR EVERYONE ONE LASER FOR EVERYONE ABOUT OUR LASER MACHINE RESULTS DRIVEN With a diode 810nm is considered by many practitioners the best wavelength for laser hair removal offering optimal treatment results. FASTER

More information

Palomar Icon Clinical Training. Permanent Hair Reduction

Palomar Icon Clinical Training. Permanent Hair Reduction Palomar Icon Clinical Training Permanent Hair Reduction Palomar Icon Aesthetic System Any treatment guidelines or parameters contained herein are intended for reference only and should not be substituted

More information

Skin Types & Conditions GEL

Skin Types & Conditions GEL Skin Types & Conditions There are various skin types and conditions that you must be able to analyse in order to give the client the best possible treatment and advice. In order to be able to recognise

More information

BEFORE YOUR TAN AFTERCARE

BEFORE YOUR TAN AFTERCARE BEFORE YOUR TAN Please shower, shave & exfoliate your skin. You MUST exfoliate with a non-abrasive exfoliant, preferably Infinity Sun pineapple enzyme Exfoliant. (If you use a salt or beaded exfoliant

More information

X-Plain Acne Reference Summary

X-Plain Acne Reference Summary X-Plain Acne Reference Summary Introduction Nearly 17 million people in the United States have acne, making it one of the most common skin diseases in the USA. Although acne is not a serious health threat,

More information

The skin. The skin is the external layer of the body Variable thickness (frictional forces) Several functions as :

The skin. The skin is the external layer of the body Variable thickness (frictional forces) Several functions as : The skin The skin is the external layer of the body Variable thickness (frictional forces) Several functions as : Protection (mecanical, physical and chemical) Metabolism (production of vitamin D) Thermoregulation

More information

INFORMED CONSENT DERMABRASION

INFORMED CONSENT DERMABRASION INFORMED CONSENT DERMABRASION INSTRUCTION This is an informed-consent document which has been prepared to help your plastic surgeon inform you about dermabrasion, its risks, and alternative treatments.

More information

ELECTROLYSIS- INFORMATION AND FAQ s

ELECTROLYSIS- INFORMATION AND FAQ s ELECTROLYSIS- INFORMATION AND FAQ s 1. How does Electrolysis work? A very fine sterilized filament is inserted into the hair follicle, which is a natural opening in the skin. The skin is not pierced or

More information

SPECIALISED WAXING HAND & FEET TREATMENTS

SPECIALISED WAXING HAND & FEET TREATMENTS SPECIALISED WAXING (Patch Test required for all waxing 24 hours prior to treatment) Californian: 25 Hot Wax 5 extra Brazilian: 35 Hot Wax 5 extra Hollywood: 35 Hot Wax 5 extra HAND & FEET TREATMENTS Vinylux

More information

Patient information from BMJ

Patient information from BMJ Patient information from BMJ Last published: Dec 02, 2016 Wrinkles Almost everyone gets wrinkles as they get older. There's no cure for wrinkles but if they bother you there are treatments that can make

More information

Narrow Band (TL-01) Treatment

Narrow Band (TL-01) Treatment Narrow Band (TL-01) Treatment Narrow Band (TL-01) Treatment This information is intended to provide you with information about your treatment and should be read thoroughly so that you are aware of the

More information

Natural Nail Treatments. Distinction Gel Nails. CND Acrylic Nails. Shellac Treatments

Natural Nail Treatments. Distinction Gel Nails. CND Acrylic Nails. Shellac Treatments Natural Nail Treatments Polish Change 7.00 5.25 File and Polish 12.00 9.00 Mini Manicure 18.50 13.88 Manicure 23.50 17.63 Mini Pedicure 19.50 14.63 Pedicure 28.00 21.00 Male Manicure 21.50 16.13 Male Pedicure

More information

New England Dermatology & Laser Center 3455 Main Street, Suite 5 Springfield, MA

New England Dermatology & Laser Center 3455 Main Street, Suite 5 Springfield, MA New England Dermatology & Laser Center 3455 Main Street, Suite 5 Springfield, MA 01107 413-733-9600 ABLATIVE FRACTIONAL CO2 LASER RESURFACING: PATIENT INFORMATION AND INSTRUCTIONS Fractional laser resurfacing

More information

TOPIC 1: ELECTROLYSIS AND OTHER METHODS OF REMOVING UNWANTED HAIR

TOPIC 1: ELECTROLYSIS AND OTHER METHODS OF REMOVING UNWANTED HAIR HAIR REMOVAL 16 Date: Rating: Text pages: 344 379 TOPIC 1: ELECTROLYSIS AND OTHER METHODS OF REMOVING UNWANTED HAIR 1 The removal of superfluous hair is a service offered by most salons a) What is the

More information

Laser and Cosmetic Center

Laser and Cosmetic Center Laser and Cosmetic Center A Patient s Guide to Cosmetic Dermatology WELCOME Experts You Can Trust The Massachusetts General Hospital Dermatology Laser and Cosmetic Center s depth of experience is unmatched.

More information

RESULTS YOU CAN SEE AND FEEL

RESULTS YOU CAN SEE AND FEEL RESULTS YOU CAN SEE AND FEEL You do a lot to look and feel great, finding the time to enjoy life to the fullest while still taking care of your body. Yet, the effects of sun, pollution, stress and fatigue

More information

Pre and Post Procedure Treatment for Permanent Makeup

Pre and Post Procedure Treatment for Permanent Makeup Pre and Post Procedure Treatment for Permanent Makeup Pre Procedure Instructions: We highly recommend you use the Homeopathic medication Arnica Montana prior to and following your lip color procedure.

More information

Laser Resurfacing. Birmingham Regional Skin Laser Centre

Laser Resurfacing. Birmingham Regional Skin Laser Centre What is laser resurfacing? Laser resurfacing is a treatment to help reduce the appearance of raised birthmarks, moles, acne scarring and sun-damaged skin. It can also help to reduce and reshape the nose

More information

SKIN CLEAR AND BRILLIANT CONSENT

SKIN CLEAR AND BRILLIANT CONSENT SKIN CLEAR AND BRILLIANT CONSENT Patient Name Date Do not sign this form without reading and understanding its contents. The nature of the Clear + Brilliant procedure has been explained to me. Clear +

More information

REVERSE PRODUCT TRAINING This advanced training establishes the link between the conditions of dull skin, dark marks, and sun damage.

REVERSE PRODUCT TRAINING This advanced training establishes the link between the conditions of dull skin, dark marks, and sun damage. REVERSE REGIMEN REVERSE PRODUCT TRAINING This advanced training establishes the link between the conditions of dull skin, dark marks, and sun damage. Nine years ago Dr. Rodan and Dr. Fields clinically

More information

This information is intended as a general guide only. Please ask if you have any questions relating to this information.

This information is intended as a general guide only. Please ask if you have any questions relating to this information. Foam Sclerotherapy (Varicose vein injections) Vascular Surgery This information is intended as a general guide only. Please ask if you have any questions relating to this information. Varicose Veins Veins

More information

o A non-chemical, fragrance-free sunscreen that contains zinc or titanium dioxide such as Blue Lizard Australian Sunscreen Sensitive

o A non-chemical, fragrance-free sunscreen that contains zinc or titanium dioxide such as Blue Lizard Australian Sunscreen Sensitive Department of Dermatology 5 East 98 th Street 5 th Floor Box 1048 New York, NY 10029-6574 Tel 212.241.9728 Fax 212.426.3160 We are here for you 24/7 If you have any concerns, at anytime please page Dr.

More information

SIDE EFFECTS. ction? A skin reaction. skin rea. tumour in your. when you. body. The skin

SIDE EFFECTS. ction? A skin reaction. skin rea. tumour in your. when you. body. The skin R a diation Th erap y and C a ring for Y our S kin The purpose of this pamphlet is to give you information about caring for your skin during and after radiation therapy. SIDE EFFECTS Radiation therapy

More information

Pre and Post Care Sheet

Pre and Post Care Sheet Pre and Post Care Sheet Recommendations for Pre & Post Body Contouring & Wraps For most significant result schedule 3-6 sessions, spaced 5-20 days apart, on specific area; Wraps can be as soon as 48hrs.

More information

Acne (Acne Vulgaris) A common type of bacteria that lives on the skin, known as Propionibacterium acnes, sometimes

Acne (Acne Vulgaris) A common type of bacteria that lives on the skin, known as Propionibacterium acnes, sometimes Acne (Acne Vulgaris) Acne, clinically known as acne vulgaris, is the most common skin disease. It affects 85% of teenagers, some as young as 12, and often continues into adulthood. It is also called pimples,

More information

AcneBooklet_A02.qxp 25-04-2007 14:05 Side 1. Acne treatment CLINICALLY PROVEN SAFE AND EFFECTIVE

AcneBooklet_A02.qxp 25-04-2007 14:05 Side 1. Acne treatment CLINICALLY PROVEN SAFE AND EFFECTIVE AcneBooklet_A02.qxp 25-04-2007 14:05 Side 1 Acne treatment CLINICALLY PROVEN SAFE AND EFFECTIVE AcneBooklet_A02.qxp 25-04-2007 14:05 Side 2 AcneBooklet_A02.qxp 25-04-2007 14:05 Side 3 At some point in

More information

Skin Care During Radiation Therapy. What is a skin reaction? How long will I have a skin reaction?

Skin Care During Radiation Therapy. What is a skin reaction? How long will I have a skin reaction? Skin Care During Radiation Therapy The most common side effect from radiation treatments is a skin reaction. Regardless of what area of the body is being treated, most patients will have a skin reaction.

More information

The Rotherham NHS Foundation Trust. Laser hair removal service. Dermatology. patientinformation. Your health, your life, your choice, our passion

The Rotherham NHS Foundation Trust. Laser hair removal service. Dermatology. patientinformation. Your health, your life, your choice, our passion The Rotherham NHS Foundation Trust Laser hair removal service Dermatology patientinformation Your health, your life, your choice, our passion Bring your medicines when you come into hospital Prescription

More information

USER GUIDE. powered by

USER GUIDE. powered by USER GUIDE powered by 1 WELCOME TO SMOOTHSKIN GOLD Welcome to an unparalleled beauty experience with your new SMOOTHSKIN GOLD Intense Pulsed Light (IPL) hair removal system. With SMOOTHSKIN GOLD, you can

More information

INFORMED CONSENT LASER RESURFACING PROCEDURES OF SKIN

INFORMED CONSENT LASER RESURFACING PROCEDURES OF SKIN Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All

More information

FRAXEL TREATMENT CONSENT

FRAXEL TREATMENT CONSENT FRAXEL TREATMENT CONSENT Patient Name Date Do not sign this form without reading and understanding its contents. The nature of the FRAXEL:RESTORE DUAL procedure has been explained to me. Fraxel Dual is

More information

Eyelid Surgery. Eyelid Surgery for Women & Men. What is eyelid surgery?

Eyelid Surgery. Eyelid Surgery for Women & Men. What is eyelid surgery? Eyelid Surgery for Women & Men What is eyelid surgery? Eyelid Surgery Also known as blepharoplasty, eyelid surgery improves the appearance of the upper eyelids, lower eyelids, or both, and gives a rejuvenated

More information

Save Face Dermal Fillers Fact Sheet

Save Face Dermal Fillers Fact Sheet Save Face Dermal Fillers Fact Sheet Patient information Dermal Fillers ª ª The majority of brands are made from hyaluronic acid ª ª Immediate results ª ª Single treatment ª ª Minimal downtime ª ª Lasts

More information

Radiation Oncology Patient information. Radiation Therapy for breast cancers

Radiation Oncology Patient information. Radiation Therapy for breast cancers Radiation Oncology Patient information Radiation Therapy for breast cancers Radiation Therapy for breast cancers 1 Radiation therapy for breast cancer Radiation therapy plays a vital role in treating and

More information

Creighton Laser Consultants. Creighton Family Medicine-Twin Creek Carlos Prendes MD Nancy Rounds CMA Joseph Stangl PAC

Creighton Laser Consultants. Creighton Family Medicine-Twin Creek Carlos Prendes MD Nancy Rounds CMA Joseph Stangl PAC Creighton Laser Consultants Creighton Family Medicine-Twin Creek Carlos Prendes MD Nancy Rounds CMA Joseph Stangl PAC 2 Overview The different layers of the skin The skin s role in the human body Hair

More information

Facial Plastic and Cosmetic Laser Services

Facial Plastic and Cosmetic Laser Services She is board-certified in doctor lists for She is board-certified in doctor lists for Cosmetic procedures Blood vessel growths (angiomas) An angioma is a benign growth made from small blood vessels and

More information

A Perfect Touch Permanent Makeup Imagine permanent, no-run, waterproof color, hassle-free! Always fresh, Always Beautiful!

A Perfect Touch Permanent Makeup Imagine permanent, no-run, waterproof color, hassle-free! Always fresh, Always Beautiful! A Perfect Touch Permanent Makeup Imagine permanent, no-run, waterproof color, hassle-free! Always fresh, Always Beautiful! (970) 389-0904 CLIENT REGISTRATION FOR PERMANENT MAKEUP (Please complete all information)

More information

Bethesda, MD I Germantown, MD Sibley Northwest DC

Bethesda, MD I Germantown, MD Sibley Northwest DC A Comprehensive Cosmetic & Medical Dermatology Practice Menu of Spa & Cosmetic Services Roberta F. Palestine, M.D. Medical Director T h r e e l o c a t i o n s Bethesda, MD I Germantown, MD Sibley Northwest

More information

DERMATOLOGY & COSMETIC LASER CENTER

DERMATOLOGY & COSMETIC LASER CENTER DERMATOLOGY & COSMETIC LASER CENTER MEET DR. NATALIE H. DANIELS Practicing medical, cosmetic, and surgical dermatology is my passion, which is why I m committed to the total health of my patients skin.

More information

Fall 2014 Prices subject to change

Fall 2014 Prices subject to change Fall 2014 Prices subject to change LASER HAIR REMOVAL Ask about our choose 2 body parts, pay for 1 package price. Face 100 Lip or chin 50 Underarms 85 Bikini line 100 Mexican 150 Brazilian 200 Half legs

More information

How Does the UNBLEMISH Regimen Work?

How Does the UNBLEMISH Regimen Work? How Does the UNBLEMISH Regimen Work? Based on Multi-Med Therapy, UNBLEMISH is a complete skincare system that combines cosmetic and OTC ingredients that penetrate pores to eliminate acne blemishes before

More information

FRANCHISING INFORMATION 2014

FRANCHISING INFORMATION 2014 FRANCHISING INFORMATION 2014 ONE OF THE LEADING & MOST TRUSTED LASER & SKIN CLINICS BUSINESS BACKGROUND leading & most trusted laser clinics... As pioneers of the Laser and Paramedical Skin industry,

More information

F r e q u e n t l y A s k e d Q u e s t i o n s

F r e q u e n t l y A s k e d Q u e s t i o n s Acne who specializes in treating skin problems) about how you can help prevent acne and if treatment would help you. Q: What is acne? A: Acne is a disorder that causes outbreaks of skin lesions commonly

More information

38 October 2016 Skin Inc. Reproduction in English or any other language of all or part of this article is strictly prohibited.

38 October 2016 Skin Inc.  Reproduction in English or any other language of all or part of this article is strictly prohibited. 38 October 2016 Skin Inc. www.skininc.com Reproduction in English or any other language of all or part of this article is strictly prohibited. 2016 Allured Business Media. The Rainbow of Skin Sensitivity

More information

Informed consent Laser resurfacing procedures of skin

Informed consent Laser resurfacing procedures of skin Informed consent Laser resurfacing procedures of skin Instructions This informed-consent document has been prepared to help inform you about laser resurfacing procedures of skin, its risks, as well as

More information

Wound Healing Sequelaes Post Body Transplantation (Variations In Healing Course Following Body Hair Transplantation)

Wound Healing Sequelaes Post Body Transplantation (Variations In Healing Course Following Body Hair Transplantation) Persons with Fitzpatrick type 3-6 skins are prone to healing with initial hyperpigmentation (much like the dark marks that you get temporarily subsequent to an acne attack) Sometimes, instead of dark pigments,

More information