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Consent Form Laser Hair Removal
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Laser Hair Removal
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No Contraindications are present
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Fitzpatrick Skin Type
• • •
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Skin Baseline Exam
• • •
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Comment
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Skin Baseline Exam: Comment
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Laser Device Used
• • •
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Area Treated 1
• • •
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Laser Energy Used
• • •
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Area Treated 2
• • •
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Laser Energy Used
• • •
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Area Treated 3
• • •
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Laser Energy Used
• • •
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Area Treated 4
• • •
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Laser Energy Used
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Pulse Count
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Follow Up
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Laser done by
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Post Laser Instructions Given
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New Field
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