Consent and Liability Form for Repeat Laser Treatment
Areas Being Treated:
List any medications you are currently taking or have taken within the last two weeks:
List any new medical conditions or skin conditions diagnosed since your last treatment:
Have you had any of the following since your last visit:
Explain all or any new prescription skin products used in the last two weeks?
Have you had any changes in the appearance of your skin from any of the previously treated areas from laser hair removal?
If yes, please explain:
Are you pregnant or breastfeeding?
Leave this empty:
Your legal name
Your email address
Signed by Bonnie Kelly
Signed On: July 5, 2023
If you have questions about the contents of this document, you can email the document owner.
Document Name: Consent and Liability Form for Repeat Laser Treatment
Agree & Sign