I consent and authorise Luxury Skin clinics to perform laser tattoo removal on me. I understand the following points and have had the opportunity to ask questions during my consultation.*

treatment is successful on most clients but my individual results cannot be guaranteed.*

Most clients require 8 to 10 treatments to achieve up to 80% of pigmentation reduction some may require more outcome will vary an individual results depend on many factors thus it is extremely difficult to advise on an exact number of treatment required.*

Darker skin type clients will require additional treatment.*

Exposure to UV rays will compromise my treatment, therefore I will use SPF 30+ sunscreen.*

Home care requirements.*

Treatment process.*

Side-effects.*

This is a checkbox.

Pigment changes (light or dark spots on the skin) lasting 1 to 6 months, and freckles may temporarily or permanently disappear in treated area. Other potential risk includes crusting, itching, pain, bruising, pimple like bumps, dry skin, Hypopigmentation (lightening of the skin) hyper pigmentation (darkening of the skin) blistering, burns infection, scabbing, swelling, a very small risk of scarring and failure to achieve the desired results.*

Allergic or delayed inflammatory reactions can develop; a test patch is performed to assess reaction of the skin.*

Laser can cause eye injury and protective eyewear must be worn during treatment.*

I consent to photographs taken to evaluate effectiveness photographs revealing my identity will not be used without consent.*

I understand laser tattoo removal treatment is uncomfortable and may be quite painful.*

I understand lighter coloured ink, such as white, yellow, orange and light green, will be ineffective.*

I am age 18 years or over*

I will advise Luxury Skin Clinics of any changes that occur during my treatment that can increase potential risk or reduce efficacy.*

I also understand there will be no refund for any performed services.*

I have not had unprotected sun exposure (including tanning beds and fake tan) in the last four weeks.*

I have no history of seizures and I have disclosed all known allergies.*

I'm not taking medications causing photo sensitivity.*

I do not have a history of keloid or hypertrophic scar formation.*

I do not have active infections/immunosuppression.*

I do not have open lesions in area being treated.*

I do not have herpes type one or two in the area being treated.*

I have not used tretinoin (Retin- A, Renova) within the last 2 weeks.*

I have not had laser resurfacing within the last 6 months.*

I have not had a chemical peel within the last four weeks.*

I have advised my technician if I am diabetic.*

I am not pregnant.*

I have not used oral isotretinoin or Accutane within the last 6 months.*

I have received the pre-and post care information. I agree to adhere to all these recommendations.*

I acknowledge the 24-hour cancellation policy and acknowledge that all deposits will be kept if this appointment is no showed cancelled or rescheduled within the 24 hours.*

I have read all of the above and had all my questions satisfactorily answered. NOTE: Do not sign this form until you have read and understood all above.*