IPL Hair Removal Booking

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IPL HAIR REMOVAL BOOKING

Achieve smooth, hair-free skin with our professional IPL (Intense Pulsed Light) hair removal treatments. Using advanced technology, IPL targets the hair follicle to reduce and prevent regrowth, providing a long-lasting solution for unwanted hair on the face and body. Our experienced therapists tailor each session to your skin type and hair colour, ensuring effective, safe, and comfortable results. Suitable for multiple areas, IPL hair removal helps you enjoy silky, smooth skin with minimal upkeep, giving you confidence and freedom from daily shaving or waxing.

Step 1 of 5 – Your Details

Name(Required)

Prefix First Last

Date of Birth(Required)

DD slash MM slash YYYY

Contact Number(Required)

Email(Required)

Enter Email Confirm Email

Emergency Contact Name(Required)

Prefix First Last

Emergency Number(Required)

Treatment Requested(Required)

Hair Removal

Skin Rejuvenation

Vascular

Pigmentation

Acne

Tattoo Removal

Fractional Laser

illumiFacial

Other

Body Area(s)(Required)

Please State(Required)

Lifestyle & Medical History – Please select as appropriate.

Pregnant (or planning pregnancy) PCOS/hormonal imbalance

Sun tanned/using sun beds or fake tan Thyroid condition

Skin pigmentation disorders (e.g. melasma, vitiligo)

Regular smoker

History of cancer (or chemo/radio therapy)

Psoriasis/eczema

Diabetes Depression/anxiety

Epilepsy Herpes (shingles/cold sores)

Lymphatic/immune system disorders High blood pressure

History of keloid formation/scarring Photosensitive conditions

Lupus

Communicable diseases (hepatitis/HIV)

If you do not understand or recognise the condition then please discuss with your laser/IPL operator.

Allergies(Required)

Units alcohol/week(Required)

Useful comments(Required)

Are you: Currently taking any medication or any supplements?(Required)

No/Yes (please specify the condition & medications)

Currently using/used in the last 6 months, any of the following?(Required)

St John’s Wort

Amiodarone

Minocycline

Anticoagulants

Gold Medications

Oral or Topical Retinoids (e.g Roaccutane or Retin A)

Oral or Topical Steroids

None

If you do not understand or recognise the condition then please discuss with your laser/IPL operator.

Recovering from any major medical treatment or photodynamic therapy (PDT) within the last 6 months?(Required)

No/Yes (please specify)

Does the area for treatment have:(Required)

Moles

Birthmarks

Tattoos

Permanent makeup

Chemical peel

Botox

Injectable fillers

Tanning Injections or Enhancers

None

Skin disorder/disease?(Required)

No/Yes (please specify)

Had previous Laser or IPL treatment?(Required)

No/Yes (please specify)

Your skin: What products do you use on your skin?(Required)

Please indicate how your skin responds to midday summer sun exposure with no sunscreen:(Required)

Do you currently have a real or fake tan?(Required)

Yes/ No

How long ago was your last UV exposure?(Required)

Have you ever used tanning injections/enhancers/Melanotan?(Required)

Yes/No

What are your goals/expectations for the treatment?(Required)

Please read this consent form and TICK each box to indicate you understand and accept the information contained herein

Consent(Required)

The information I have given is correct to the best of my knowledge, and I have not withheld any known medical state or condition. I will inform the IPL/Laser operator before treatment if there has been any change (for example in medications taken).

I understand that the results from this treatment vary considerably and a small percentage of people will not respond satisfactorily to treatment.

I understand multiple treatments are necessary to achieve satisfactory results.

I understand there is no guarantee of permanent results and maintenance treatments may be necessary.

I understand that I must avoid sun exposure on the treated area for the duration of the treatment (and for up to 1 month afterwards) or use a high sun protection factor to avoid sun damage. I understand that tanned skin cannot be treated.

I understand that there may be short-term side effects such as reddening, bruising, swelling, mild burning or blistering, hypo-pigmentation, (lightening of the skin) or hyper-pigmentation, (darkening of the skin), as well as rare side effects such as scarring and permanent discolouration.

I understand that pigmented areas caused by sun damage may initially turn darker. This will be followed by ‘micro-crusting’ of the lesion, after which it should flake away leaving an area without excess pigmentation.

I understand that I must wear protective eye goggles to prevent damage from the light.

I agree that my contact details can be used to be kept updated about special offers and other information about the clinic and its services that might be of interest.

I certify that I have read and understood all the information and my questions have been answered satisfactorily before signing this consent form. I consent to the terms of this agreement.