11550 Jonesbridge Rd, Suite# 6, Alpharetta GA 30022
Email: email@example.com Tel: (678) 829-7722
Laser Tattoo Removal Consent Form
I, consent to and authorize Cosmo Med Spa & Salon and members of his/her staff to perform multiple
treatments, laser procedures and related services on me. The procedure planned uses laser technology for the removal of tattoos.
As a patient you have the right to be informed about your treatment so that you may make the decision whether to proceed for laser tattoo
removal or decline after knowing the risks involved. This disclosure is to help to inform you prior to your consent for treatment about
the risks, side effects and possible complications related to laser tattoo removal:
The following problems may occur with the tattoo removal system:
THE UNDERSIGNED acknowledges that I am 18 years of age or older and the Specialist has explained the nature of all the above noted
treatment of Laser Tattoo Removal 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.)