INFORMED CONSENT FORM FOR LASER EPILATION PROCEDURE
The purpose of the explanations in this form is not to worry you, but to enlighten you in a scientific framework about the before - during - after and possible risks of the procedure to be applied. Please read carefully. If you have questions or points you do not understand, ask for help.
1. Personal Information
Please fill out this section completely.
Name:
Surname:
Date of birth:
Gender:
Mobile number:
Signature:
2. What is Laser Epilation Application and For What Purpose Is It Used?
Laser epilation is the practice of removing unwanted hair with laser beams. It is based on the principle that controlled laser beams destroy the target dark hair follicle cells. Therefore, the success of epilation is related to the color and thickness of the hair.
3. What are the points to be taken into consideration before laser epilation?
Please answer the following questions completely.
1. Do you have any infection in the application area or in your body? YES NO
2. Do you have a chronic disease such as diabetes? YES NO
3. Do you have an allergy, immune system or rheumatic disease? YES NO
4. Have you had any surgery? YES NO
5. Do you have an active skin disease or do you have herpes attacks? YES NO
6. Are you prone to bleeding? YES NO
7. Are you positive for hepatitis (HBsAG, HCV) or AIDS (HIV)? YES NO
8. Are you at risk of pregnancy, pregnancy or breastfeeding? YES NO
9. QHave you used any medication in the past 1 week? YES NO
10. Have you used blood thinners (aspirin, coumadin, etc.) in the last 3 days? YES NO
11th. Have you had any dermatological or aesthetic procedures in the last month? YES NO
12. Have you tanned with the sun or a tanning bed in the last few weeks? YES NO
13. If you have had this procedure done before, have there been any problems? YES NO
WRITE BELOW THE SITUATIONS WHEN YOU ANSWERED YES TO THE QUESTIONS OR WOULD YOU WANT TO EXPLAIN OTHER THAN THE QUESTIONS.
4. How is Laser Epilation Applied and What is the Course of Its Effect?
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You may experience a slight feeling of pain during laser epilation, but it may be more in some sensitive areas. If it becomes too disturbing, you need to report it.
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Laser epilation sessions are continued regularlyOtherwise, it is possible to get rid of most of the hair.
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If there is a hormonal disorder due to various reasons, the success of laser epilation may be low. In addition, although good success is achieved after laser epilation, hormonal imbalances that may occur later can cause hair to grow again.
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Although the session intervals vary from region to region, they should be 4-8 weeks. After each session, you can be told when you should come and we can also arrange your sessions according to you.
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For a successful laser epilation application, 6-8 consecutive sessions may be required, although this varies from person to person.
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Before laser epilation, the hair in the area to be treated should be shortened to 1-2 mm in length between 1-3 days without irritating the skin. If it is not shortened, you can have it shortened by paying an additional fee.
5. What are the points to be taken into consideration after laser epilation?
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In the application area, solarium should be avoided and sunbathing should not be done after the application.
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During your procedure, a moisturizer and sunscreen that does not have a hair growth effect should be applied to the treated area.
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After the procedure, hot showers should not be taken for 12 hours and lukewarm water should be used.
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After the procedure, no scrub should be applied to the applied area for 14 days.
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If an unexpected effect develops, please contact our center.
6. What are the Risks and Side Effects of Laser Epilation Application?
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As with all transactions, there are some risks in this transaction.
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In the application area
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Redness (erythema)
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uLocal swelling in the application area
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Swelling of hair follicles (perifollicular edema)
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crusting
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Burns may occur.
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Darkening or lightening of the skin color may occur in the application area.
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In upper lip applications, existing herpes, if any, may spread.
The side effects mentioned above are unlikely to occur. These side effects generally occur as a result of not paying attention to sun protection, using devices that are not suitable for the area, and not adjusting the doses properly. Besides, they are not permanent.
APPROVAL OF THE PERSON TO BE TRADED
This procedure is not of vital importance like other cosmetic applications.is. Cosmetic procedures are non-medical performed to reduce the negative effects on your skin such as wrinkles, lines, spots, scars, tattoos, capillaries, hair loss, sagging, stretch marks, unwanted hair, lack of moisture or unpleasant facial and body appearances.interventionare ales. For reasons that are not fully understood, the success and permanence of the procedure may be shorter than expected. Additionally, no guarantee can be given regarding the results of the application. Any side effects that may occur will be evaluated by our center and improvement procedures (prescription adjustment, medical intervention, emergency intervention) will be carried out by our center's contracted doctor in the doctor's office. You can reach us at any time through the communication channels provided to you by our center.
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I was explained and understood that no cosmetic intervention, medical intervention or treatment could be performed on me without my permission.
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I have read the text above containing the information that must be given before LASER EPILATION application. I understand the expected effect and risks of the method to be applied.
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In addition, other application options, possible consequences and risks were explained to me, written and verbal explanations were made to me about this procedure, necessary warnings were given and I understood it.
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I was in a position to ask questions about the trading options to be applied and their risks. My questions and concerns were discussed and answered to my satisfaction.
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It was stated to me that visual material samples (such as photographs) could be taken before, during and after the procedure in order to evaluate the effectiveness of the procedure to be performed, and I agreed.
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I understand that no guarantee is given as a result of the procedure to be performed on me.
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I did not encounter any coercive behavior in purchasing this application.
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Under these conditions, I voluntarily agree to have LASER EPILATION and pay the necessary costs for this application.
THE PERSON TO whom the APPLICATION IS MADE
Name and surname:
History:
Signature:
THE PERSON WHO MAKES THE APPLICATION
Name and surname:
History:
Signature:
THE PERSON WHO WITNESSED THE APPLICATION
Name and surname:
History:
Signature: