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Informed Consent for Laser Tattoo Removal

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 system:

  1. The 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.

ACKNOWLEDGMENT:

            My 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 information above.

I confirm 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.

Informed Consent for Laser Tattoo Removal

  • Date Format: MM slash DD slash YYYY
  • We would like to send you details of how to look after your tattoo or piercing via email along with any special promotions we may run from time to time. Please confirm if you are happy to receive emails from us by checking one of these boxes.