11550 Jonesbridge Rd, Suite# 6, Alpharetta GA 30022 Email: info@cosmomedspaatl.com Tel: (678) 829-7722 Fractionated CO2 Laser Resurfacing Consent Form
I understand that erythema (redness) and edema (swelling) are common immediate reactions from the fractionated CO2 laser treatment process. These typically resolve within 2 weeks but can last longer. There is a possibility of rare side effects such as blisters, hyper pigmentation, hypo pigmentation, infection, or scarring may occur. I may also feel a warning sensation of the skin during treatment. This is a temporary condition and I understand that each person’s discomfort level may vary. I understand that 1-3 treatments are required for the fractionated CO2 laser to be most effective. I understand that it is important to follow the recommended maintenance schedule for future treatments to keep the best possible results. I also realize that each individual’s treatment response may be different; therefore, the number of treatments may vary to achieve desired results. I understand sun exposure, tanning beds, sunless tanning lotions and tanning cream can cause discoloration or a reaction prior to or during the course of laser treatments. A broad spectrum (UVA/UVB) sunscreen SPF 30 or greater should be applied to the area(s) to be treated whenever exposed to the sun. I understand and agree that all about aesthetics may choose to take photos of my treatment area for the purpose of monitoring my progress. I also understand that once I’ve started my treatment program there are no refunds. Patients with open wounds, malignant skin tumors and certain diseases, tattoos, or currently taking Accutane cannot be treated.
Waiver Agreement THE UNDERSIGNED acknowledges that TECHNICIAN has explained the nature of all the above noted treatment of Fractionated CO2 Laser Resurfacing procedures including the risks and dangers inherent therein. I HEREBY CONSENT to performing the above-noted treatment procedures on me and in consideration of their so doing; I hereby release and forever discharge Cosmo Med Spa & Salon, from all claims, demands, damages, actions or causes of action arising out of the performance of the said treatment procedures, which I, my heirs, executors, administrators or assigns can, shall, or may have. (NO REFUND ON ANY TREATMENT.)