#103 7228 192 St Surrey BC
778-889-0620
Laser Hair Removal Consent Form
Client Name
(Required)
Full Name
Phone
(Required)
Email
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Age (must be 18+)
(Required)
I confirm I am OVER 18 years old:
Yes
No
Area(s) to be Treated:
(Required)
Skin Type (Fitzpatrick I‒VI):
Technician Name:
Date
(Required)
MM slash DD slash YYYY
CONSENT & RISKS
Laser hair removal reduces hair growth but may not completely remove hair.
Multiple sessions are required for optimal results.
Possible temporary side effects include redness, swelling, itching, and mild sensitivity.
Results may take time and vary from person to person.
Hair reduction depends on your hormonal system and response may differ.
Treatment progress will follow the technician’s professional instructions.
I have avoided sun exposure, tanning beds, or self-tanner on the treated area for at least 2 weeks.
I agree to follow all pre-care and aftercare instructions.
HEALTH INFORMATION (YES / NO)
Pregnant/Breastfeeding
(Required)
Yes
No
Photosensitivity
(Required)
Yes
No
Epilepsy
(Required)
Yes
No
Heart Conditions
(Required)
Yes
No
Diabetes
(Required)
Yes
No
Metal Implants
(Required)
Yes
No
Accutane (last 6 months)
(Required)
Yes
No
Skin Disorders (eczema/psoriasis)
(Required)
Yes
No
Notes / Medications:
NO LIABILITY AGREEMENT
I understand individual results vary.
I release Laser Club & Beauty Bar from liability related to training-model procedures.
I understand all deposits are
NON-REFUNDABLE
.
CONSENT & LIABILITY WAIVER
(Required)
CONSENT & LIABILITY WAIVER By submitting this form, I agree to the following terms regarding my treatment at RK Beauty Club. 1. Informed Consent, Capacity & Voluntary Decision I confirm that I am 18 years of age or older (or have a legal guardian present) and have the legal capacity to consent. I have read and understood the details of the treatment I am requesting. I have had the opportunity to ask questions regarding the procedure, risks, benefits, alternatives, and expected outcomes, and all questions have been answered to my satisfaction. I confirm that I am choosing this treatment voluntarily, without coercion, and I understand I may withdraw my consent at any time before or during the procedure. 2. Medical Accuracy & Responsibility I certify that the medical history and health information I have provided is truthful, accurate, and complete. I understand that undisclosed conditions, allergies, or medications (e.g., blood thinners, Accutane) may affect my safety and the treatment outcome. I assume full responsibility for any adverse reactions resulting from my failure to disclose such information. 3. Risk Acknowledgement & No Guarantees I understand that all aesthetic procedures carry inherent risks, including but not limited to: pain, redness, swelling, blistering, scarring, discoloration, sensitivity, infection, allergic reactions, and healing variations. I acknowledge that results are not guaranteed, may vary by individual, and that "touch-ups" or additional sessions may be required at my own expense. 4. Aftercare Commitment I agree to strictly follow all pre- and post-treatment instructions provided by RK Beauty Club. I understand that failure to follow these instructions may increase the risk of complications, infection, or altered results, for which the clinic cannot be held responsible. 5. Financial Policy & Refunds I understand and agree to the clinic’s financial policy. I acknowledge that all payments and deposits are non-refundable (except where required by law). I also agree to provide at least 48 hours' notice for cancellations to avoid forfeiture of deposits or cancellation fees. 6. Release of Liability I hereby release, waive, and discharge RK Beauty Club, its owners, technicians, and staff from any liability, claims, or demands related to treatment outcomes, complications, or reactions that result from my consented procedure, except in cases of proven gross negligence. 7. Data Privacy & Media Release Privacy: I understand that my personal and medical information will be collected, stored, and used in accordance with applicable privacy laws (e.g., PIPA/PIPEDA). Media: Unless I have explicitly indicated otherwise in writing, I grant permission for before/after photos and videos of my treatment to be used for training, educational, and marketing purposes.
Consent
(Required)
I have read, understood, and agree to the Consent & Liability Waiver terms.
Signature
(Required)
Type in Your Full Name
