Foreverbyash

LASER CONSENT FORM

IPL is a broadband pulsed light source it can be used effectively to destroy targets located in the skin with minimum damage to the surrounding tissues. IPL Light is used to lighten, fade or remove photodamaged skin, veins, and/or hair removal in a non-ablative manner.

I understand it may take multiple treatments to obtain optimal results for hair reduction and IPLS. Although these devices are effective in most cases, no guarantees can be made. I understand I may not experience complete clearance, and that it may take multiple treatments. Some conditions may not respond at all and, in rare cases, may become worse.

RISKS OF IPL - Although it is impossible to list every potential risk and complication, Because IPL penetrates the skin, it inherently carries health risks, including but not limited to those listed below. You should discuss any and all health concerns with your esthetician or attending healthcare provider PRIOR to signing this consent form.

PIGMENT/COLOR CHANGE During the healing process, there is a possibility that the treated area can become either lighter (hypopigmentation) or darker (hyperpigmentation) in color compared to the surrounding skin. This is usually temporary, but on a rare occasion, it may be permanent. Failure to follow post treatment instructions can put you at risk for hyperpigmentation. You MUST avoid direct sun exposure for one week after the treatment. You should also wear a daily SPF facial moisturizer, which your esthetician can recommend.

SCARRING Scarring is a rare occurrence, but it is a possibility if the skin surface is disrupted. To minimize the changes of scarring, it is IMPORTANT that you follow all post-treatment instructions carefully and apply sunscreen to treated exposed areas if exposed

PAIN Mild discomfort may be experienced during the treatment. A sudden reappearance of redness or pain is a sign of infection and you should notify our office immediately.

REDNESS/SWELLING/BRUISING/SCABBING -Short term redness or swelling of the treated area is common for 5-10 minutes but could be prolonged. Adverse reactions may include hyper and hypopigmentation, burning, scarring, blistering, redness, swelling, itching and other similar side-effects and reactions. Please contact the office if any persistent redness or discomfort occurs.

ALLERGIC REACTION A variety of products may be used on the face in conjunction with the treatment such as cooling gel, sunscreen, facial cleanser, jelly mask/cooling/soothing mask to which an allergy can occur. Additionally, it increases the penetration of topical substances, it can cause you to be hypersensitive to products used on the face. If an allergic reaction were to occur, you must contact our office immediately or notify your esthetician of any abnormal feeling during the treatment.

LACK OF PERMANENT RESULT The treatment may not completely or permanently improve skin texture, tone, elasticity, hyperpigmentation, scars, or minimize fine lines and wrinkles. It is important that your expectations be realistic and understand the procedure has its limitations. Additional procedures may be necessary to achieve desired effect.

LASER HAIR REDUCTION - Most people usually need 6-8 treatments to see a significant reduction of hair growth in some cases you may need more. Furthermore, you will need a touch up depending on hair growth once all of your sessions are complete. Hormones and blonde hair can have lacking results. In this case electrolysis is recommended.

CONTRAINDICATIONS TO IPL- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form.

• Active acne or use of Accutane within 1 year • Active infection of any type (bacterial, viral, or fungal) • Cardiac disease/abnormalities • Chemotherapy or radiation • Eczema, Psoriasis, or Dermatitis • Pregnancy / Lactation • Raised lesions (moles, warts, etc.) • Recent chemical peel/microneedling/microdermabrasion procedure(2 weeks) • Recent use of some topical Retinol (72 hours) . • Rosacea • Sunburn severe exposure within (2 weeks) • Tattoos • Uncontrolled diabetes • Melasma • Self tanner ( 2 weeks) Removing hair by the root e.g. waxing or tweezing 4 weeks prior to treatment (hair removal only) • Raised body temperature 2 hours prior/after treatment.

If you have any of the above please notify your esthetician immediately.


My signature below acknowledges that I have read and understand the content of this informed consent. I understand that results can vary and that no guarantee, neither expressed nor implied, has been or will be, given to me regarding my results. I’m aware of the risks and benefits associated with this procedure, as well as available alternative treatments. I understand it is an elective procedure, performed solely for cosmetic purposes, and is not critical to my health. On my own free will, I am requesting and providing my informed consent, to undergo the treatment. I assume all risks as my own and agree to hold harmless my provider Ashley Holdings LLC/ Foreverbyashh LLC and all of it's subsidiaries . I hereby release them from any liability, both seen and unforeseen, now and forever.