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Birthday
Day
Month
Year
Treatment Requested
Multi choice
Schedule an appointment
May - Jun 2026
SunMonTueWedThuFriSat
Week starting Sunday, May 31
Time zone: Coordinated Universal Time (UTC)Business location
Sunday, May 31
10:00 AM - 11:00 AM
11:00 AM - 12:00 PM
12:00 PM - 1:00 PM
1:00 PM - 2:00 PM
Currently using / used in the last 6 months any of the following?
Does the area for the treatment have:
Skin disorder or diseases?
Yes
No
had previous Laser or IPL treatment
Yes
No
Single choice
Skin Type 1, always burns
Skin Type 2; Easily bnseventually gets a moderate tan
Skin Type 3: Sometimes burns quickly gets a deep tan
Never burns, consistent tan
Do you currently have a real or fake tan?
real
Fake
per treatment checklist - to be completed by the operator.

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.

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