Client InformationClient NameEmail AddressPhone NumberDate of BirthHealth Questionnaire Please provide details where applicable:Existing or Recent IllnessHospitalization / SurgeryMedication IntoleranceAesthetic Procedures in the Treatment Area:Medical History Please check all that apply and inform your service provider:Pregnancy or currently nursingUnder 18 years of age (unless parental/guardian consent is provided)Pacemaker, internal defibrillator, or any electronic implant (e.g., glucose monitor)Permanent implants in the treatment area (metal plates, screws, silicone implants, injected substances)Current or previous history of cancer, especially skin cancer, or pre-malignant molesImmunosuppressive disease (e.g., AIDS, HIV) or use of immunosuppressive medicationsSevere concurrent conditions (e.g., cardiac disorders, epilepsy, uncontrolled hypertension, liver or kidney disease)Heat-stimulated conditions (e.g., recurrent herpes simplex in the treatment area) – prophylactic treatment may be requiredActive skin conditions in the treatment area (e.g., sores, psoriasis, eczema, rash, sunburn, excessive tanning)History of abnormal wound healing or skin disorders (e.g., keloids, fragile or infected skin)Tattoos, permanent makeup, or pigmented lesions in the treatment areaAny medical condition that may impair skin healingPoorly controlled endocrine disorders (e.g., diabetes, thyroid dysfunction)Any surgical, invasive, or ablative procedure in the treatment area within the past 3 months or without full healingUse of Isotretinoin (Accutane®) within the last 6 monthsAcknowledgment and Consent: I confirm that I have fully read and understood the information provided above. I have disclosed all relevant medical history, conditions, and medications to my service provider. I understand that laser hair removal results vary based on skin type, hair color, and other individual factors, and that multiple treatments are often necessary for optimal results. I acknowledge the risks, possible side effects, and benefits associated with this procedure and hereby voluntarily consent to receive Laser Hair Removal services at Unique Styles Hair and Esthetics. I release Unique Styles Hair and Esthetics, its technicians, and affiliates from any liability related to this procedure, understanding that every precaution will be taken to ensure my safety and satisfaction. Post-Treatment Care: Following your laser hair removal session, it is important to avoid sun exposure, tanning beds, and excessive heat (such as hot showers, saunas, and steam rooms) for at least 48 hours. Apply a broad-spectrum sunscreen with SPF 30 or higher daily, keep the area clean and moisturized, and avoid waxing or plucking between treatments. Redness and mild swelling are normal and should subside within 24–48 hours; cold compresses and gentle skincare can help. Please contact Unique Styles Hair and Esthetics if you experience any unusual discomfort or signs of infection.Client NameClient SignatureDateSend Message
