Contact

Laser Hair Removal Consultation & Consent Form

1. Treatment Request

2. Medical & Health Screening

PregnantTrying to become pregnantBreastfeedingPacemaker or implanted medical deviceEpilepsy / seizuresDiabetesHormonal disorder / PCOSAutoimmune diseaseImmune suppressionActive cancer or history of skin cancerKeloid or hypertrophic scarring historyVitiligoPsoriasis / eczema / dermatitis in treatment areaActive infection / cold sore / rash / broken skinSuspicious mole or changing skin lesion in treatment areaRecent surgery in treatment areaNone of the above

3. Medication Screening

Roaccutane / Isotretinoin in the last 12 monthsTopical retinoids / tretinoin / adapaleneAntibiotics in the last 4 weeksPhotosensitising medicationSteroidsBlood thinnersHormonal medicationHerbal / supplements affecting skin sensitivityNo current relevant medication

4. Skin & Hair Assessment

5. Recent Sun / Tanning / Hair Removal

Sun exposure in the last 2 weeksFake tan / spray tan in the last 2 weeksSolarium / tanning bed in the last 4 weeksWaxing / plucking / threading / epilator in the last 4 weeksBleaching hair in the last 2 weeksShaving in the last 48 hoursNone of the above

6. Contraindications / Client Declarations

[acceptance* contraindications-consent]
I declare that the information I have provided is true and complete to the best of my knowledge.
[/acceptance]

[acceptance* lesion-consent]
I understand that if I have any suspicious mole, skin lesion, infection, rash, broken skin, or unusual pigmentation in the treatment area, treatment may be refused or postponed and I may be referred to a medical practitioner.
[/acceptance]

[acceptance* patch-test-consent]
I understand that a patch test and clinical assessment may be required before treatment, and treatment settings may be changed or treatment declined based on safety.
[/acceptance]

[acceptance* risk-consent]
I understand the possible side effects and risks may include discomfort, redness, swelling, perifollicular oedema, blistering, burns, pigmentation changes, crusting, scarring, paradoxical hair stimulation, and incomplete hair reduction.
[/acceptance]

[acceptance* results-consent]
I understand that multiple sessions are usually required and that results vary depending on skin type, hair colour, hormones, medications, and adherence to aftercare.
[/acceptance]

[acceptance* eye-protection-consent]
I agree to wear appropriate protective eyewear during treatment and follow all operator instructions.
[/acceptance]

[acceptance* aftercare-consent]
I agree to follow pre-care and aftercare instructions, including avoiding tanning, excessive sun exposure, and any contraindicated products or procedures as advised.
[/acceptance]

[acceptance* consent-to-contact]
I consent to Lux Look Beauty & Laser Clinic contacting me regarding this consultation and appointment.
[/acceptance]

I consent to SMS reminders and promotional messages.