Consent & Health Screening

Laser Hair Removal Consent

Please complete this before your first laser or IPL appointment. It takes about three minutes, and it means we can treat you safely and at the right settings.

How your information is used. Evergreen Essence collects these details only to assess whether a treatment is safe and suitable for you, and to keep a record of your care. They are not sold or shared, and are kept only as long as needed. To see, correct or delete your information, email evergreenessencespa@gmail.com.

About you

 Step 1
Street, city and postal code.

Treatment area

 Step 2

Laser follows pigment, so we need to know both your hair and your skin.

This is your Fitzpatrick skin type — it sets the laser settings we use.

Health screening

 Step 3

Answering yes does not automatically rule you out. It tells us what to check, adjust, or get clearance for.

  • Are you pregnant, breastfeeding, or trying to conceive?
  • Have you had sun exposure, a sunbed, or used fake tan on the area in the last 4 weeks?
  • Have you waxed, plucked, threaded or epilated the area in the last 4 weeks?
  • Are you taking any medication that increases light sensitivity?Antibiotics, retinoids, St John's Wort, some heart and blood pressure medication.
  • Have you taken Accutane / isotretinoin in the last 12 months?
  • Do you have epilepsy or a history of seizures?
  • Are there tattoos or permanent makeup on or near the area?
  • Are there moles, warts or raised pigmented marks in the area?
  • Do you get cold sores (herpes simplex)?
  • Do you scar badly, or have you ever had a keloid scar?
  • Do you have eczema, psoriasis, vitiligo or any active skin condition in the area?
  • Have you had laser or IPL before?
  • Do you have diabetes, an autoimmune condition, or are you under a doctor's care?

Anything else we should know

 Step 4
Please list anything you answered yes to above, plus any allergies (including topical anaesthetic and latex).

What I understand

 Step 5

Your signature

 Final step
By typing your full legal name below you are signing this form electronically. This carries the same weight as a handwritten signature.

A copy goes straight to Evergreen Essence. Nothing is shown publicly.

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