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Informed Consent for IPL/Laser Treatment
Please read this consent form and TICK each box to indicate you understand and accept the information contained herein.
• The information I have given i s correct to the best of my knowledge, and I have not withheld any known medical state or
condition. I will inform the IPL/Laser operator before treatment if there has been any change (for example in medications taken).
I understand that the results from this treatment vary considerably and a small percentage of people will not respond
satisfactorily to treatment.*
I understand multiple treatments are necessary to achieve satisfactory results.*
I understand there is no guarantee of permanent results and maintenance treatments may be necessary.
l understand that I must avoid sun exposure on the treated area for the duration of the treatment land for up t o 1 month
afterwards) or use a high sun protection factor to avoid sun damage. I understand that tanned skin cannot be treated*
I understand that there may be short-term side effects such as reddening, bruising, swelling, mild burning or blistering,
hypo-pigmentation, (lightening of the skin) or hyper-pigmentation, Idarkening of the skin), as well as rare side effects such as
scarring and permanent discolouration.