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Everton Park  +61 459 627 100     &       Aspley +61 481 332 100

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Everton Park  +61 459 627 100   Aspley +61 481 332 100

Laser Vein Removal Consent Form

HomeFormsLaser Vein Removal Consent Form

Laser Vein Removal Consent Form

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Full Name(Required)
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Laser Vein Removal

You have been recommended for treatment of spider veins and/or broken capillaries using a laser therapy. Laser treatment is designed to target and reduce the appearance of spider veins and broken capillaries by using focused light energy to destroy the unwanted veins, which will then be absorbed by the body over time.

Benefits of Spider Veins and Broken Capillaries Removal

1. Improved Aesthetic Appearance. 2. Non-Invasive Procedure. 3. Precise Treatment. 4. Long-Term Results. 5. Improved Circulation and Blood Flow. 6. Quick and Convenient. 7. Minimal Pain. 8. Safe for Most Skin Types. 9. Minimal Risk of Scarring.

Does it work?

Laser treatment for spider veins and broken capillaries works by using focused light energy to target and break down the unwanted blood vessels. This process is both precise and effective, offering a non-invasive way to reduce or eliminate these veins without causing significant damage to the surrounding tissue. 1. Laser Energy Absorption by Blood Vessels Targeting Hemoglobin: The laser emits specific wavelengths of light that are absorbed by hemoglobin (the protein in red blood cells that carries oxygen). These wavelengths are chosen because they are absorbed by the blood vessels but not by the surrounding skin or tissue. Heat Generation: When the hemoglobin absorbs the laser light, it heats up the blood inside the capillaries and spider veins. This heat causes the vein walls to collapse and coagulate (clot), effectively shutting down the blood flow in the treated vessel. 2. Vessel Closure and Absorption Sealing the Vein: The heat from the laser causes the treated vein to collapse and seal shut. As the vein coagulates, it can no longer carry blood, and the body begins to reabsorb the now-closed vein over time. Gradual Fading: Once the vein is closed and the blood flow is stopped, the vein will begin to fade from view. The body’s lymphatic system helps to break down and remove the treated vein from the skin. Over the course of several weeks, the vein will typically become less visible, and the skin will return to its normal, clear appearance.

What’s the procedure like?

Laser Application: Positioning: The practitioner will position a handheld laser device over the targeted area. The device emits light energy that is directed at the spider veins or broken capillaries. Laser Pulses: The practitioner will activate the laser, which delivers short pulses of light energy to the veins. The laser targets the blood vessels without harming the surrounding skin. The light is absorbed by the hemoglobin in the veins, which generates heat that causes the blood vessels to collapse and eventually fade.

Is it safe and are there any side effects?

Laser treatment for spider veins and broken capillaries is generally considered safe. However, like any medical or cosmetic procedure, there are some potential risks and side effects that you should be aware of before proceeding. Common Side Effects and Risks: Though laser treatments are generally safe, there are some temporary side effects and, in rare cases, potential risks. Below are the most common side effects, along with some of the less common, more serious risks: Common and Temporary Side Effects: Redness or Swelling: What it is: After treatment, it's common to experience redness and mild swelling in the treated area, similar to a mild sunburn. How long it lasts: This typically resolves within a few hours to a few days. Why it happens: The skin reacts to the heat and energy applied by the laser. Bruising: What it is: Some patients may notice bruising in the treated area, especially if larger veins were targeted. How long it lasts: Bruising usually fades within 1-2 weeks. Why it happens: The laser causes some minor trauma to the blood vessels, which can lead to temporary bruising. Mild Pain or Discomfort: What it is: You may experience a mild stinging, burning, or pinching sensation during the treatment, which is often described as being similar to the snap of a rubber band against the skin. How long it lasts: Discomfort typically subsides immediately after treatment. Why it happens: The laser energy is absorbed by the blood vessels, causing them to heat up and collapse, which can cause brief discomfort. Skin Sensitivity: What it is: Treated skin may feel sensitive or tender for a short period. How long it lasts: This is usually temporary and lasts just a few days to a week. Why it happens: The skin is reacting to the laser's heat and energy. Less Common but Serious Side Effects: Hyperpigmentation (Darkening of the Skin): What it is: In rare cases, the skin in the treated area may become darker than usual (hyperpigmentation), especially in individuals with darker skin tones. How long it lasts: This can be temporary, but in rare cases, it may last for several months or longer. Why it happens: The laser can stimulate pigment production in the skin. This is more common in individuals with darker skin tones or those who have excessive sun exposure after the treatment. Hypopigmentation (Lightening of the Skin): What it is: The treated area may become lighter than the surrounding skin (hypopigmentation), although this is rare. How long it lasts: This can be permanent or temporary, depending on how the skin reacts. Why it happens: The laser treatment can sometimes damage the skin’s pigment cells, leading to lighter skin in the treated area. Blistering: What it is: Though uncommon, there is a risk of developing small blisters in the treated area, especially if the skin is overheated. How long it lasts: Blisters typically heal within a few days to weeks, but may leave a scar in some cases. Why it happens: Blisters may form if the laser energy is too intense or improperly applied, or if the skin is sensitive. Scarring: What it is: There is a very small risk of scarring after laser treatment, especially if the treated area is not properly cared for afterward. How long it lasts: If scarring occurs, it may be permanent. Why it happens: Scarring can occur if the skin is damaged by the laser, or if there is an infection after treatment. Infection: What it is: While rare, an infection can develop if the treated area is not properly cared for. How long it lasts: Infections can be treated with antibiotics, but if left untreated, they may cause longer-term issues. Why it happens: Infection can occur if the skin is broken or irritated after treatment. Temporary Dark Spots: What it is: Some patients may develop temporary dark spots (or age spots) in the treated area, especially after exposure to sunlight. How long it lasts: These usually fade with time but may persist for several months if not properly managed. Why it happens: The laser treatment can cause the skin to be more sensitive to UV light, which can trigger pigmentation changes.

Recovery

The recovery process after laser treatment for spider veins and broken capillaries is typically quick and relatively uncomplicated, with most patients being able to return to their normal activities right away. What to Expect Immediately After the Treatment: You might get skin sensitivity, redness and swelling, Bruising.

Let your skin heal – to avoid scars

The skin which have been treated then develop a scab or crust. This looks like small brown/black spots all over the skin which has been treated. The key to scarring or not scarring is partly due to how you look after the scabs. To avoid scarring you need to:

• Keep the scabs clean by washing them in cool boiled water.
• Do not pick them – let them drop off, even though they’ll be very itchy!
• Don’t use anything which can tangle and tug them off.
• Once they’ve dropped off, make sure you protect the skin with high SPF for at least 1 month.
Checkbox(Required)

CONSENT FORM & CONSULTATION

PLEASE READ CAREFULLY AND SIGN WHERE INDICATED, ONLY when you are happy to proceed. Ensure all points below have been discussed with your specialist. You are signing to state that you understand and accept these terms.

TO BE COMPLETED BY THE CLIENT

Photographic consent(Required)
I ALSO CONSENT TO THE USE OF MY PHOTOGRAPHS AND VIDEO FOOTAGE FREE OF CHARGE FOR MARKETING PURPOSES.(Required)
I understand that my specialist will be in direct contact with me in relation to the plasma pen treatment. This treatment involves the use of a disposable probe. All other equipment is sterilized before use, all surfaces involved in the process are protected and gloves will be worn at all times by the specialist during the treatment.
I hereby consent to receiving a plasma pen treatment. My specialist has explained the terms and conditions of the treatment and I have fully understood these. I hereby give written consent to the specialist who is carry out the treatment of my choice as requested by me on this consent and treatment agreement.

MEDICAL FORM (To be completed by the client)

Gender(Required)
Have you received any vein removal treatment before?(Required)
Were you happy with the result?(Required)
Are you over the age of 18?(Required)
Are you pregnant?(Required)
Are you under the influence of alcohol or drugs?(Required)
Are you in good health?(Required)

MEDICAL CONDITIONS Please answer YES or NO to the following questions.

Do you feel fit and well enough to have a vein removal procedure today?(Required)
Do you have any allergies or have you experienced any allergic reactions to medicine or products such as latex gloves, plaster, etc?(Required)
Are you currently taking any medication?(Required)
Do you have or are you planning to have any injectables, fillers or chemical peels in the near future?(Required)
Do you suffer from epilepsy?(Required)
Do you knowingly suffer from any infectious diseases?(Required)
Do you suffer from high or low blood pressure?(Required)
Do you suffer from diabetes?(Required)
Do you have any respiratory problems?(Required)
Do you suffer from, or have any problems with scars healing?(Required)
Do you suffer from dizziness or fainting attacks?(Required)
Do you suffer from HIV/AIDS?(Required)
Do you suffer from heart problems?(Required)
Do you suffer from Hepatitis?(Required)
Do you suffer from any Lymphatic problems?(Required)
Do you suffer from Haemophilia?(Required)
Do you suffer from skin problems (i.e. Eczema, Psoriasis)?(Required)
Do you suffer from Keloid scarring?(Required)
If you suffer from any of the above it is important that you notify your specialist who can take the necessary precaution to ensure you receive the best treatment to avoid any risks to your health.

1st Lady health & beauty CONSULTATION RECORD

Initial(Required)

TREATMENT PLAN

This part of the consultation record is to be completed by the specialist in order to record important elements of the treatment. This form must be kept with the clients Medical and Consent forms.
Clinical report(Required)
Please ask your client to read, understand and sign the following prior to treatment: I, the client, agree with all points listed and discussed, and wish to proceed as recorded. I participated fully in the decision for selected area or areas intended for my treatment. I hereby agree to follow after advice.

To be completed by the client after filling above form:

My procedure has been explained and I am satisfy and I have been given the opportunity to discuss any immediate concerns with my specialist.
I fully understand my aftercare instructions and have my aftercare advice.

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    • Cosmetic Tattoo Makeup
    • Tattoo Removal
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    • Cryolipolysis fat freezing
    • Spider Veins and Vascular Treatment
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    • Laser Carbon Peel
    • Cosmelan Depigmentation Skin Treatment
    • Mole, skin tag, wart removal
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