• IPL Treatment Informed Consent

    Medical History
  •  - -
  •  -
  • IPL Treatment Informed Consent

    Medical History Page 2
    • Flaking of pigmentated lesions - crust may take 5 to 10 days to disappear and it is important not to manipulate or pick which may otherwise lead to scarring
    • Discomfort - During the procedure, I might experience a sensation similar to a rubber band snap which degree will vary per my skin condition and area sensitivity but that does not last long.  A mild "Sun-Burn" sensation may follow for typicalluy up to one hours and will be reduced with application of cooling and soothing creams.
    • Reddening and swelling - severity and duration depend on the intensity of the treatment and the senisitiviy of the area to be treated.  The phenomena may be reduced with application of cooling and/or anti-inflammatory creams
    • Brusing may rarely occur and may last up to 2 weeks. 
    • Natural or artificial sun exposure in the past 3-4 weeks pre-op or the following 3-4 week post-op plan
    • Use of self–tanners or tan enhancer caps within the past 3-4 weeks pre-op plan
    • Photosensitive herbal preparations (St John’s Wort, Ginkgo Biloba, etc) or aromatherapy (essential oils)
    • Diseases which may be stimulated by light at 400 nm to 1200 nm, such as history of Systemic Lupus Erythematosus or Porphyria
    • Pregnant or possibility of pregnancy, postpartum or nursing
  • IPL Treatment Informed Consent

    Medical History Page 3
  • IPL Treatment Informed Consent

    Medical History Page 4
  • My signature certifies that I have duly read and understood the content of this informed consent form, and gave the accurate information as to my health condition. I hereby freely consent to M22 IPL skin treatments

  • Clear
  •  / /
  •  
  • Should be Empty: