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PibuMD AESTHETICS Laser Hair Removal Consent

I hereby authorize the provider or staff to perform light based hair reduction on me. I understand that this procedure works on the growing hairs (anagen) and not on dormant hairs. I understand that I will require several treatments to obtain a significant, long-term reduction of hair growth. I understand I may experience fewer, thinner, lighter, slower re-growth of hairs, temporary hair loss or permanent hair reduction. I understand that it is only effective on hair with color and does not treat white, grey, blond, or red hair. I understand that genetics, hormones, medication and hair color may interfere with hair loss and that I may not respond at all.


The procedure may result in the following adverse experiences or risks: 

  • DISCOMFORT/PAIN – Some discomfort and/or pain may be experienced during treatment.

  • REDNESS/SWELLING/BRUISING – Short term redness (erythema) or swelling (edema) of the treated area is common and may occur. There also may be some bruising.

  • HYPOPIGMENTATION / HYPERPIGMENTATION: (Changes in skin Color): – During the healing process, there is a slight possibility that the treated area may become either lighter (hypopigmentation) or darker (hyperpigmentation) in color compared to the surrounding skin. This is usually temporary, but, on a rare occasion, it may be permanent.

  • WOUNDS – Treatment can result in burning, blistering, or bleeding of the treated areas.

  • SUN EXPOSURE / TANNING BEDS / ARTIFICIAL TANNING - May increase risk of side effects and adverse events. If any of these occur, please call our office.

  • INFECTION – Infection is a possibility whenever the skin surface is disrupted, although proper wound care should prevent this. Signs of infection develop, such as pain, heat, or surrounding redness, please call our office.

  • SCARRING – Scarring is a rare occurrence, but it is a possibility if the skin surface is disrupted. To minimize the chances of scarring, it is IMPORTANT that you follow all post-treatment instructions provided by your healthcare staff.

  • PARADOXICAL HAIR GROWTH – Stimulation of terminal hair growth following photo-epilation. Can occur within or adjacent to the treated area.

  • LEUKOTRICHIA - Temporary or permanent gray hair

  • EYE EXPOSURE – Protective eyewear (shields) will be provided to you during the treatment. Failure to wear eye shields during the entire treatment may cause severe and permanent eye damage.


I acknowledge the following points have been discussed with me:

  • Potential benefits of the proposed procedure, including the possibility that the procedure may not work for me

  • Alternative treatments such as electrolysis, waxing, plucking and depilatories

  • Reasonably anticipated health consequences if the procedure is not performed

  • Possible complications/risks involved with the proposed procedure and subsequent healing period


For women of childbearing age: By signing below I confirm that I am not pregnant and don't intend to become pregnant anytime during the course of treatment. Furthermore, I agree to keep the practitioner and staff informed should I become pregnant during the course of treatment. 


Photographic documentation will be taken. I hereby authorize the use of my photographs for teaching purposes.

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