11550 Jonesbridge Rd, Suite# 6, Alpharetta GA 30022 Email: email@example.com Tel: (678) 829-7722 IPL Consent Form
I authorize Cosmo Med Spa to perform Intense Pulsed Light (IPL) treatments on me in an effort to improve Dyschromia, Hyperpigmentation, Sun Damage, Hemangioma,Angioma, Telangiectasia, Rosacea, and/or Leg veins. I understand that there is a rare possibility of side effects or serious complications including permanent discoloration or scarring. I am aware of the short-term side effects and agree to follow all post care instructions. I understand that sun exposure or tanning of any sort is prohibited while undergoing these treatments. The procedure as well as potential benefits and risks have been thoroughly explained to me and I have had all my related questions answered. Pre and post-care instructions have been discussed and are completely clear to me. I understand that results may vary with each individual and acknowledge that it is impossible to predict how I will respond to the treatment and how many sessions will be required.