I, consent to and authorize Glyn Uren to perform multiple treatments, of laser procedures on me.
As a patient you have the right to be informed about your treatment so that you may make the decision whether to proceed for laser tattoo removal knowing the risks involved. This disclosure is to help to inform you prior to your consent to treatment about the risks, side effects and possible complications related to laser tattoo removal.
The following problems may occur with the tattoo removal
possible risks of the procedure include but are not limited to pain,
purpura, swelling, redness, bruising, blistering, crusting/scab formation,
ingrown hairs, infection, and unforeseen complications which can last up to
many months, years or permanently.
is a risk of scarring.
term effects may include reddening, mild burning, temporary bruising or
blistering. A brownish/red darkening of the skin (known as hyperpigmentation) or lightening of the
skin (known as hypopigmentation) may
occur. This usually resolves in weeks, but it can take up to 3-6 months to
heal. Permanent colour change is a rare risk. Loss of freckles or pigmented
lesions can occur.
and/or colour changes in the skin can occur and can be permanent. Many of
the cosmetic tattoos and body tattoos are made with iron oxide pigments. Iron
oxide can turn red-brown or black. Titanium oxide and other pigments may also
turn black. This black or dark colour
may be un-removable. Because of the immediate whitening of the exposed
treated area by the laser, there can be temporary obscuring of ink, which can
make it difficult or impossible to notice a specific colour change from the
tattoo removal process.
Pinpoint bleeding is rare but can occur following treatment procedures, should
bleeding occur, additional treatment may be necessary.
Reactions: There have been reports of
hypersensitivity to the various tattoo pigments during the tattoo
removal process especially if the tattoo pigment contained Mercury, cobalt or
chromium. Upon dissemination, the pigments can induce a severe allergic reaction
that can occur with each successive treatment. Noted in some patents are
superficial erosions, bruising, blistering, redness and swelling which can last
up to many months, years or permanently.
- Compliance with the aftercare guidelines is
crucial for healing, prevention of scarring, and hyper-pigmentation. Aftercare
guidelines include avoiding the sun for 2 months after the procedure. If it is
necessary to be in the sun, a sunscreen with SPF 25 or greater must be used.
- I understand that multiple treatments will be
necessary to achieve results. And confirm that No guarantee, warranty or
assurance has been made to me as to the results that may be obtained, or any
number of sessions confirmed or implied. Complete tattoo removal is not always
possible as tattoos were meant to be permanent.
you have had any other form of tattoo removal treatment that has resulted in dis-colouring
or scarring then you must be aware that the laser treatment may result in
further scaring and may prove ineffective.
questions regarding the procedure have been answered satisfactorily. I
understand the procedure and accept the risks. I hereby release Glyn Uren and
the establishment where treatment took place from all liabilities associated
with the above procedure. I have been given, read and understand the
that I have been told that laser removal is not successful for all and that I
may not achieve the fading or complete removal desired and have read and fully
understood this consent form
By signing this consent form, you are irrevocably giving permission to Reds Tattoo Parlour employees to take and use photographs, video and voice recording. This is completely voluntary and up to you. Your consent to the use of the photographs and videos is for forever. You will not receive compensation for the use of your image likeness, appearance, and voice now or in the future. Reds Tattoo Parlour may use the photographs and video for advertising purposes, including use on web pages.