Laser Hair Removal Consultation

Personal Details

Full name *

Date of birth *

Phone number *

Email address

Area(s) to be treated *

Medical History

Please answer yes or no. If yes, add details in the box provided.

Do you have any skin conditions? e.g. eczema, psoriasis, rosacea, vitiligo

Yes No

Do you have a history of cold sores or herpes simplex?

Yes No

Do you have any active infections, wounds or skin irritation in the treatment area?

Yes No

Do you have epilepsy?

Yes No

Do you have a pacemaker or metal implants?

Yes No

Have you ever been diagnosed with skin cancer, or are you currently undergoing any cancer treatment?

Yes No

Do you have diabetes or any condition affecting skin healing?

Yes No

Do you have a history of keloid scarring?

Yes No

Any other medical conditions we should be aware of?

Current Medications

Are you currently taking any medications?

Yes No

Are you currently taking Roaccutane (isotretinoin)? Treatment cannot go ahead if yes — a 6-month pause is required

Yes No

Are you taking antibiotics or any photosensitising medication? e.g. certain acne treatments, antifungals, diuretics

Yes No

Skin, Tanning & Hair

What is your natural skin tone? *

Type I

Very fair, always burns

Type II

Fair, usually burns

Type III

Medium, sometimes burns

Type IV

Olive, rarely burns

Type V

Brown, very rarely burns

Type VI

Deep, never burns

Have you used a sunbed or been on holiday in the last 4 weeks?

Yes No

Have you used fake tan in the last 2 weeks?

Yes No

What is the natural hair colour in the treatment area? *

Have you waxed, epilated or had electrolysis in the last 4 weeks?

Yes No

Previous Hair Removal

Have you had laser hair removal before?

Yes No

Have you had IPL (Intense Pulsed Light) treatment before?

Yes No

Pregnancy

Are you currently pregnant or breastfeeding? Laser hair removal is not recommended during pregnancy or breastfeeding

Yes No

Consents & Declaration

Full name (signature) *

Date *

Laser HairRemoval Consultation

⚡ Before your appointment — please read

Laser Hair
Removal Consultation