Consent IPL SHR | The Aesthetic Chapter Singapore

Name *

First

Last

Last 4 Digits Of IC Number

Have you had significant sun exposure in the last 6 weeks?

Have you been treated with hormone medication?

Have you had surgery in the last 6 months?

Does your skin get blotchy, red or irritated easily?

Are you currently pregnant or trying to conceive?

I Acknowledge The Following

I duly authorized the staff to perform the IPL / SHR Treatment on me
I am aware that multiple treatments may be necessary to achieve satisfactory results.
The treatment may not produce permanent hair removal /skin rejuvenation /pigmentation or red blood vessel reduction. Due to the nature of this treatment an exact result cannot be predicted and I acknowledge that no guarantees have been made to me as to the results that may be obtained.
Possible side effects of the area can include mild discomfort, swelling and colour changes may develop.
Colour changes such as hyperpigmentation (brown /red discolouration) or hypopigmentation (skin lightening) may occur in treated skin. This may take several months to return to normal.
Skin must be protected from the sun for several weeks before and after treatment. Unprotected sun exposure in the weeks following treatment may worsen a condition that has hyperpigmentation.
Blistering and mild crusting of the skin may occur. Scarring is a rare possibility but it has occurred in less than 1% of the treatment population.
Client must use proper eye protection as recommended by the Technician
My questions regarding this procedure have been answered to my satisfaction. I accept all risks of treatment and agree to provide aftercare as directed by this company. I consent to photographs for the purpose of monitoring response to therapy.

Consent For IPL / SHR