Aura Consent Forms

Personal / Contact Details

Name

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Date of Birth (dd/mm/yyyy)

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Email Address

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Phone Number

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Postcode

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Address

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Therapist

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Patch Test All of our products undergo extensive testing in line with industry standards and comply with all applicable requirements to ensure that they are safe. However a person's reaction to any product is personal to them and products of any kind can cause allergy or other reactions.
We strongly recommend that all of our customers participate in a skin sensitivity test at least 48 hours prior to the full application of any product, to reduce the risk of an adverse reaction, even if previously used. However, you are responsible for your own safety and it is your decision as to whether you wish to participate in a test or not. Please tick the box applicable to you below, then sign and date this Consultation Form to confirm your understanding of this.
I have undergone an allergy/skin sensitivity test. I do, however, acknowledge that applying any product to the skin or hair is never entirely without risk.

Patch Test Date (dd/mm/yyyy)

Have you had Laser Hair Removal before?	Yes No
Have you had extreme sun exposure in last 4 weeks?	Yes No
Have you had Waxing/Plucking/Electrolysis within the last 4 weeks?	Yes No
Would you like us to email you our special offers?	Yes No

Medical/Lifestyle History

Pre Treatment Instructions:

1. Do not remove your hairs with wax, electrolysis or hair removal cream.

2. Do not bleach the hairs.

3. Do not expose the area to extreme sunbed damage for a minimum of 2 weeks before and after.

4. Do not apply oil on the area lasered prior to the treatment and two weeks post treatment.

5. If there is a change in your medication, it is your responsibility to let us know.

I am aware of the following possible experience/risks:

DISCOMFORT: Some discomfort may be experienced during treatment.

REDNESS: Short term redness (erythema) or swelling (edema) of the treated area is common and may occur. On rare occasions minor blistering may occur.

INFECTION: Infection is a possibility whenever the skin surface is disrupted, although proper wound care should prevent this.

SCARRING: Scarring it a rare occurrence, but there is a possibility if the surface of the skin is sensitive.

EYE EXPOSURE: Protective eyewear (Shields) will be provided.

The following points have been discussed with me:

1. Benefits, results and contraindications.

2. Possible alterative procedures such as electrolysis, waxing, plucking and depilatories.

3. Post-treatment advice

I hereby consent the AURA therapist to perform Laser hair removal treatment on me.

I understand that this procedure works on the growing hairs at the anagen stage of hair growth and not on any new hairs. For this reason, complete destruction of all hair follicles from only one treatment is unlikely, and I understand that I will require a course of treatments to obtain a significant, long term result on my hair growth.

I also understand if I have a hormonal imbalance or equivalent I may require extra session. I understand that pregnancy, hormones and hair colour may interfere with the results and that it may not respond at all on white, grey, blonde or red hairs.

I CERTIFY THAT I HAVE READ AND FULLY UNDERSTOOD THE CONTENTS OF THIS CONSENT FORM AND THAT THE DISCLOSURES REFERRED TO WERE MADE TO ME. I AGREE NOT TO SUE AURA FOR DAMAGES.

NB: WE DO NOT GIVE ANY REFUNDS ON ANY LASER PACKAGES THAT HAVE BEEN PAID FOR. LASER TREATMENTS CANNOT BE TRANSFERRER ON TO FRIENDS AND FAMILY!

I HAVE RECEIVED A PATCH TEST FOR THE LASER TREATMENT AND I AM HAPPY TO RECEIVE THE TREATMENT AT MY RISK.

Total Amount Paid: 0

	Date (dd/mm/yyyy)	Laser Treatment Area	Power	Course	Therapist	Amount	Note

Would you like to complete this Treatment?

Consent Form: Disclaimer

I understand a patch test is required before I have the above treatment due to a possible reaction to the product or glue. However, I am prepared to take full responsibility with this disclaimer and will not pursue any action against the therapist or salon should there be any reaction what so ever. No refunds will be given.

Please accept Disclaimer.

Ultrasensitive Skin	Yes No	Pregnant	Yes No
Skin Allergies	Yes No	Taking Antibiotics	Yes No
Medical	Yes No	Semi Perm Make-up in last 6 months	Yes No
Recent Scarring	Yes No	Wear Pacemaker	Yes No
Medical Peels	Yes No	Hepatitis	Yes No
Blood Clot	Yes No	Laser Skin Resurfacing	Yes No
Lupus	Yes No	Plastic Surgery	Yes No
Hirsutisum	Yes No	Scars that turn white or brown	Yes No
Transplant anti-rejection drugs	Yes No	Legs ulcer or phlebitis	Yes No
Pulmonary Embolisum	Yes No	Blood thinning tables	Yes No
Going on holiday/have been on holiday	Yes No	Use Roaccutance/Retin-A in last 6 monts	Yes No
Rheumatoid arthritis Gold Therapy	Yes No	Smoking	Yes No
Cancer	Yes No	High Blood Pressure	Yes No
HIV	Yes No

Laser Hair Removal

Personal / Contact Details

Medical/Lifestyle History