MJadore English MJadore_E DATE NAME PHONE NUMBER EMAIL DO YOU HAVE A PACEMAKER? * YES NO DO YOU HAVE ANY SKIN CONDITIONS? * YES NO YOU HAVE BEEN IN THE SUN FOR A LONG TIME? * YES NO ARE YOU PREGNANT OR NURSING? * YES NO DO YOU TAKE ANY MEDICINE FOR PRESSURE? * YES NO SOME LASER TREATMENT HAS BEEN DONE BEFORE? * YES NO YOU HAVE RECENTLY HAD A CHEMICAL PEEL ON YOUR FACE? * YES NO YOU SUFFER FROM PSORIASIS ON THE SKIN? * YES NO YOU HAVE A MOLE OR TATTOO IN THE AREA TO BE TREATED? * YES NO PLEASE MARK THE AREA TO BE TREATED: ARMPITS BREAST BELLY HIPS SHIN FACE ARMS LEGS BIKINI HOW I REACT TO YOUR FIRST LASER HAIR REMOVAL PROCEDURE? DID YOU HAVE REDNESS? * YES NO DO I NOTICE A DECREASE IN HAIR GROWTH IN THE TREATED AREA? * YES NO IF NOT DID IT HAVE ANY NEGATIVE EFFECTS? * YES NO WHICH? I ACCEPT RESPONSIBILITY FOR THE TREATMENT. I RECOGNIZE THAT IT IS 6 SESSIONS TO 8 SESSIONS TO SEE RESULTS IN THE PERMA NENT REDUCTION OF UNWANTED HAIR. ALL YOUR INFORMATION IS COMPLETELY CONFIDENTIAL AND ONLY FOR PROFESSIONAL USE. CONFIDENTIALITY CONTRACT. I UNDERSTAND THAT THE LASER CAN HAVE A SIDE EFFECT SUCH AS COLOR CHANGE IN THE SKIN I UNDERSTAND AND ACCEPT RESPONSIBILITY.. NO REFUNDS AFTER A LASER SESSION THE GUARANTEE OF THE PACKAGES ONLY INCLUDES A MAXIMUM OF 12 SECTIONS AFTER THE GUARANTEE EXPIRES. I UNDERSTAND AND ACCEPT THE GUARANTEE POLICY THERE IS NO REFUND IF YOU DECIDE TO CANCEL THE TREATMENT YOU WILL BE CHARGED AT A REGULAR PRICE FOR THE SECTIONS THAT HAVE ALREADY BEEN DONE SIGNATURE OF PATIENT Clear SIGNATURE OF PROFESSIONAL Clear Fitzpatrick J2L ENVIAR If you are human, leave this field blank.
