I request and authorize  or a designated, licensed healthcare professional, using the Elite iQ™ laser, to perform a procedure on me known as:

The nature and effects of the procedure, the risks involved, as well as alternative methods of treatment have been fully explained to me by the physician or designated person, and I understand them.

I have been thoroughly and completely advised regarding the procedure. Because I understand that the practice of medicine and surgery is not an exact science and no results have been guaranteed. I certify that no guarantees have been made by anyone regarding the procedure(s) I have requested and authorized. I understand that possible adverse effects may include bleeding, infection, scarring, skin contour irregularities, asymmetry, allergic reaction and topical-anesthesia-related complications can occur and should be discussed and understood.

I understand the importance of pretreatment and posttreatment instructions and that my failure to comply with these instructions may increase the possibility of complications.

The Elite iQ™ laser produces an intense burst of light that is absorbed by the hair follicle. All personnel in the treatment room, including myself, will wear protective eyewear to prevent eye damage from this intense light.

The sensation of the light is uncomfortable and may feel like a slight pinprick or sensation of heat, which may last for a few hours.

Following the procedure, the treated area may be red and swollen for a few hours or a few days. Blistering may occur. The area should be treated delicately following treatment. Multiple procedures may be necessary. I have been informed that hyperpigmentation (darkening of the skin) and hypopigmentation (lightening of the skin) are possible risks of the procedure. I understand that sun exposure and not adhering to the post-care instructions provided to me may increase my chance of complications. I will care for the skin area(s) by gently cleaning daily with a gentle cleanser and applying a broad spectrum (UVA/UVB) sun block SPF 30 or greater.

I agree to have photographs taken of the area to be treated before/after procedure.

I have read and understand all information presented to me before signing this consent. I have also been given the opportunity to ask questions.