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Laser Consent
Treatment Requested:
Does the area for treatment have any of the following
Medical Questionnaire
Currently usng/used in the last 6 months, any of the following
Skin Disorder/disease?
Had previous laser/ IPL
Please INDICATE how your skin responds to midday summer sun exposure with no sunscreen
Do you currenty have a real or fake tan?

Advised Consent
I confirm I have been informed that:

My medical practioner may use pictures taken before and after my treatment for the follwing purposes; social media or within clinic. I have seen these pictures and agree or disagree with their use as follows (please tick appropriate boxes)​

I certify that I have read and fully understand the above consent form, I have understood the post-injection recommendations and undertake to observe them.

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