Discharge Form Laser Hair Removal

The Body Studio, LLC Laser Hair Removal Discharge Agreement
Agreement Drafting Technician:*
Client Name:*

First NameLast Name
Today's Date

MonthDayYear
For Patient
Areas to be Discharged
Treatment Start Date:

MonthDayYear
For Patient
Dates of Service*
*90 Day Appt set:

MonthDayYear
For Patient
I understand that I have completed the minimum number of sessions required to complete full treatment to the area(s) of the body above following the advised schedule given and that the hair has reduced to the desired amount of the client and the authorized discharging laser technician to be considered complete.

I understand that once the *90 Day Appointment has passed from the date on the above form that I will be required to be evaluated at the above *90 Day Appointment set above and a photo will be taken of the unshaven area (photo is not applicable to Brazilian area) to be attached to my file. Once 90 day appointment, photo and authorized laser technician signature is acquired I will be released to receive $15 (small/medium area) or $20 (large area) touch-ups as needed. I understand that $15/$20 touch ups are completed with SHR technique and will only combat lighter, finer hair.

I acknowledge that there are circumstances that can cause new hair follicles to begin producing a hair if hormone levels change such as certain medications, pregnancy, PCOS, thyroid issues, birth control pills, IUDs, hysterectomy, menopause, puberty, etc. In the case of hormone changes affecting new growth I may be responsible for a full session to reduce the new hair.
Do you authorize The Body Studio, LLC to photograph?
Patient or Guardian Signature (use your finger or iPen)*

Clear
If you’re the legal guardian of the patient receiving services from The Body Studio, LLC, you’re agreeing to this form in its entirety on the patients behalf.
Should be Empty:

The Body Studio, LLC Laser Hair Removal Discharge Agreement