EPILFREE CLIENT
CONSULTATION & CONSENT FORM
Have you ever received the following treatments?
If yes, please fill out all the relevant details:
Waxing
Laser / IPL
Varicose Vein
Botox Injections
Note: Due to the hair producing chemical IGI, Botox increases hair growth by 30%. Only affects the treated area.
Facial Skin Care: If yes to any of the below, treatment must be postponed until 7 days after last treatment.
Chemical Peels
Microdermabrasion
Microneedling
Health Information: Please tick where applicable:
Note: Medical or Hormonal conditions and/or medication taken for these conditions, or vitamins that boost hair growth, may affect the hair growth cycle and the length of the Epilfree journey towards the end result.
THE ONLY EPILFREE CONTRAINDICATION: Pregnant and/or Breastfeeding
General Health Information:
Note: If you have very high stress levels (the hormone Cortisol is released) or live a very active lifestyle (exercise), this can increase hair growth.
Client Consent:
• I confirm that I have read, understand and answered the above questions correctly to the best of my knowledge.
• I hereby declare that all the information above is true.
• I confirm that I have received an explanation of the method of treatment, of the products and their components.
• I have received an explanation of the expected results.
• It has been explained to me that the hair removal is not absolute and permanent, but that the quantity of hair is reduced over time.
• I have received an explanation that, at this time, it is known that at least 12 treatments are required for this purpose, and sometimes even more.
• I am aware of the hair growth cycles, so the treatments must continue for at least 12 months in order to cover the majority of the hair growth cycles. In the case of
of hormonal problems, the treatment period will be longer and the number of treatments greater.
• I have received an explanation that the way in which hair grows depends on many and varied factors and that the results may differ from one person to another, as
well as from one body part to the next.
• I have received information regarding the various factors that may have an effect on hair growth and results. i.e. Botox, Hormones, Medication, Stress and Activities.
• I understand that I have to follow post treatment/aftercare to achieve optimal results.
• I confirm that an Aftercare Card (printed / WhatsApp) has been given and explained to me.
• I have received an explanation that I must avoid being in the sun on the day of the treatment in order to prevent the possibility of pigmentation (which causes brown
patches) on the skin (waxing effect).
• I hereby give consent for photographs to be taken of the treated areas to assess my progress.
• I am aware of the importance of the before pictures to manage the results.
• I am aware that no warranty or guarantee is given regarding the results.
• In the case of a minor, the signature of one of the parents is required.
Therapist Declaration:
I declare to do the Epilfree treatment as trained, following all steps and protocols. I understand the importance of each and every step to ensure a result.
I agree to an evaluation after 3 treatments to assess results. I agree to check my wax patch after every removal to ensure the timing of the treatment is catching the
correct hair cycles (recommend according to the amount of roots removed). I agree that I check the hair root bulb is apparent on the wax strip after hair removal.
I agree that I gave and explained the aftercare card to the client.
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