Laser Form

I consent to and authorise Brows by Andrea to perform multiple treatments, laser procedures and related services on me. The procedure planned uses a Q Switch Nd:Yag laser for the removal or reduction of your skin imperfections.

As a patient you have the right to be informed about your treatment so that you may make the decision whether to proceed for treatment or decline after knowing the risks involved. This disclosure is to inform you prior to your consent for treatment about the risks, side effects and possible complications related to your treatment. The following problems may occur: 1. The possible risks of the procedure include but are not limited to pain, swelling, redness, bruising, blistering, crusting/scab formation, ingrown hairs, infection, and unforeseen complications which can last up to many months, years or permanently. 2. There is a risk of scarring. 3. Short term effects may include reddening, mild burning, temporary bruising or blistering. A brownish/red darkening of the skin (known as hyper-pigmentation) or lightening of the skin (known as hypo pigmentation) may occur. This usually resolves in weeks, but it can take up to 3-6 months to heal. Permanent colour change is a rare risk. Loss of freckles or pigmented lesions can occur. 4. Textual and/or colour changes in the skin can occur and can be permanent. 5. Infection: Although infection following treatment is unusual, bacterial, fungal and viral infections can occur. Herpes simplex virus infections around the mouth can occur following a treatment. This applies to both individuals with a past history of herpes simplex virus infections and individuals with no known history of herpes simplex virus infections in the mouth area. Should any type of skin infection occur, additional treatments or medical antibiotics may be necessary. 6. Bleeding: Pinpoint bleeding is rare but can occur following treatment procedures. Should bleeding occur, additional treatment may be necessary. 7. Compliance with the aftercare guidelines is crucial for healing, prevention of scarring, and hyper-pigmentation. After care guidelines include avoiding the sun for 2 months after the procedure. If it is necessary to be in the sun, a sunscreen with SPF 50 or greater must be used. 8. I understand that multiple treatments may be necessary to achieve desired results. No guarantee, warranty or assurance has been made to me as to the results that may be obtained. Complete removal is not always possible. Occasionally, unforeseen mechanical problems may occur and your appointment will need to be rescheduled. We will make every effort to notify you prior to your arrival to the office. Please be understanding if we cause you any inconvenience. ACKNOWLEDGMENT: My questions regarding the procedure have been answered satisfactorily. I am aware that a patch test is not always required due to the size of the area being treated (based on the recommended treatment coverage area per session) and hereby waver my right to a patch test being performed prior to the treatment. I understand the procedure and accept the risks.