{"id":6583,"date":"2025-03-29T07:26:18","date_gmt":"2025-03-29T07:26:18","guid":{"rendered":"https:\/\/clinic.weecode4u.com\/?page_id=6583"},"modified":"2025-03-29T07:29:26","modified_gmt":"2025-03-29T07:29:26","slug":"laser-consent-form","status":"publish","type":"page","link":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/laser-consent-form\/","title":{"rendered":"Laser Consent Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6583\" class=\"elementor elementor-6583\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b04ef48 e-flex e-con-boxed e-con e-parent\" data-id=\"b04ef48\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a908150 elementor-widget elementor-widget-wllnez-dual-headding\" data-id=\"a908150\" data-element_type=\"widget\" data-widget_type=\"wllnez-dual-headding.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wellnez-dual-heading\"><div class=\"wellnez-dual-heading-wrapper\"><h1 class=\"wellnez-dual-heading-title\"><span class=\"first-heading\">Laser Consent<\/span><span class=\"second-heading\"> Form<\/span><span class=\"thard-heading\"><\/span><\/h1><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4a91ddb elementor-widget elementor-widget-wpforms\" data-id=\"4a91ddb\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-4a91ddb\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-4a91ddb {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-6579\"><form id=\"wpforms-form-6579\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"6579\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/paralowie\/wp-json\/wp\/v2\/pages\/6583\" data-token=\"18506b187286c8f5a1aee5991adc8799\" data-token-time=\"1776402405\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-6579-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6579-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-6579-field_1-error\" required><label for=\"wpforms-6579-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6579-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-6579-field_1-last-error\" required><label for=\"wpforms-6579-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-6579-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_2\">Parent\/ Guardian&#039;s name (if client under 18 years old) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6579-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-6579-field_2-error\" required><\/div><div id=\"wpforms-6579-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_3\">Mobile Number<\/label><input type=\"number\" id=\"wpforms-6579-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\" step=\"any\" aria-errormessage=\"wpforms-6579-field_3-error\" ><\/div><div id=\"wpforms-6579-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_4\">Email Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-6579-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" aria-errormessage=\"wpforms-6579-field_4-error\" required><\/div><div id=\"wpforms-6579-field_5-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">How did you hear about us? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-6579-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_5_1\" name=\"wpforms[fields][5][]\" value=\"Google\" aria-errormessage=\"wpforms-6579-field_5_1-error\" aria-describedby=\"wpforms-6579-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_5_1\">Google<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_5_2\" name=\"wpforms[fields][5][]\" value=\"Facebook\" aria-errormessage=\"wpforms-6579-field_5_2-error\" aria-describedby=\"wpforms-6579-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_5_2\">Facebook<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_5_3\" name=\"wpforms[fields][5][]\" value=\"Instagram\" aria-errormessage=\"wpforms-6579-field_5_3-error\" aria-describedby=\"wpforms-6579-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_5_3\">Instagram<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_5_4\" name=\"wpforms[fields][5][]\" value=\"Word of Mouth\" aria-errormessage=\"wpforms-6579-field_5_4-error\" aria-describedby=\"wpforms-6579-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_5_4\">Word of Mouth<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_5_5\" name=\"wpforms[fields][5][]\" value=\"Other\" aria-errormessage=\"wpforms-6579-field_5_5-error\" aria-describedby=\"wpforms-6579-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_5_5\">Other<\/label><\/li><\/ul><div id=\"wpforms-6579-field_5-description\" class=\"wpforms-field-description\"><br \/>If any of the following apply, you may not be eligible for treatment:<\/div><\/fieldset><\/div><div id=\"wpforms-6579-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Pregnancy, Breastfeeding, or trying to conceive <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-6579-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_6_1\" name=\"wpforms[fields][6][]\" value=\"Yes\" aria-errormessage=\"wpforms-6579-field_6_1-error\" aria-describedby=\"wpforms-6579-field_6-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_6_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6579-field_6_2\" name=\"wpforms[fields][6][]\" value=\"No\" aria-errormessage=\"wpforms-6579-field_6_2-error\" aria-describedby=\"wpforms-6579-field_6-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6579-field_6_2\">No<\/label><\/li><\/ul><div id=\"wpforms-6579-field_6-description\" class=\"wpforms-field-description\"><br \/><div class=\"ff-el-group ff-custom_html\"><ul>\n<li><strong>Accutane, Isotretinoin<\/strong> (<em>must discontinue use of product 3 months before beginning treatment)<\/em><\/li>\n<li><strong>Epilepsy of those who have a history of seizure<\/strong><\/li>\n<li><strong>Diabetes<\/strong><\/li>\n<li><strong>Allergic to laser<\/strong><\/li>\n<li><strong>Current history of skin cancer, or current condition of any other type of cancer, or pre-malignant moles in area of treatment<\/strong><\/li>\n<li><strong>Active sores or rash (psoriasis, eczema) in the area to be treated<\/strong><\/li>\n<li><strong>Skin disorders such as keloid or abnormal wound healing<\/strong><\/li>\n<li><strong>History of melanoma anywhere on the body<\/strong><\/li>\n<li><strong>Recent (within 3 months) surgery, laser resurfacing, or deep chemical peel in the treatment area<\/strong><\/li>\n<li><strong>Severe medical disorder such as poorly controlled heart conditions<\/strong><\/li>\n<li><strong>Waxing, hair removal creams or chemicals, tweezing, electrolysis, bleaching in the treatment area within 4 weeks before treatment.<\/strong><\/li>\n<li><strong>Use self-tanner or spray tan products within 2 weeks before the treatment<\/strong><\/li>\n<\/ul>\n<p>I, authorize the technicians at <em>Allure Beauty and Aesthetics<\/em>\u00a0to perform Laser Hair Reduction treatment(s) on me.<\/p>\n<p>I understand that this procedure works on the growing hairs and not on dormant hairs. For this reason, complete destruction of all hair follicles from any one treatment is unlikely, and I understand that I will require several CONSECUTIVE treatments to obtain a significant, long-term reduction of hair growth. I also understand some people may not experience complete hair loss even with multiple laser procedures and some people may require more treatment than the initial series. I also understand that I will need maintenance treatments to keep the growth away.<\/p>\n<p>I understand that serious complications are rare but possible. Common side effects include temporary redness, swelling, and mid \u201csunburn\u201d like effects that may last a few hours to 3-4 days or longer on the treated area. Other potential risks include Itching, Pain, Bruising, Burn, Infection, Scabbing, Blistering, Hypopigmentation, Hyperpigmentation, Scarring, and failure to achieve the desired result(s). Color changes, such as hyperpigmentation (brown\/red discoloration) or hypopigmentation (skin lightening), may occur in the treated skin. This may take several months to resolve, if at all.<\/p>\n<p>Lasers can cause eye injury and protective eyewear must be worn during treatment.<\/p>\n<p>I understand that no refunds will be given for treatments paid in advance.<\/p>\n<p>I have read and completed the form in its entirety and in truth. I know that this form is only filled out the first-time doing Laser hair removal. In the following times, if there is any change for the above things, I will ask Allure Beauty and Aesthetics to do another consent form.<\/p>\n<p>I represent that I am over 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement.<\/p><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-6579-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_10\">Patient Signature<\/label><input type=\"text\" id=\"wpforms-6579-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-6579-field_10-error\" ><\/div><div id=\"wpforms-6579-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_11\">Patient Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6579-field_11\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-6579-field_11-error\" required><\/div><div id=\"wpforms-6579-field_9-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-6579-field_9\">Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-6579-field_9\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][9][date]\" aria-errormessage=\"wpforms-6579-field_9-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6579\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/pages\/6583\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-6579\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Laser Consent Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Name * FirstLast Parent\/ Guardian&#039;s name (if client under 18 years old) *Mobile NumberEmail Address * How did you hear about us? * Google Facebook Instagram Word of Mouth Other If any of&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6583","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/pages\/6583","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/comments?post=6583"}],"version-history":[{"count":4,"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/pages\/6583\/revisions"}],"predecessor-version":[{"id":6587,"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/pages\/6583\/revisions\/6587"}],"wp:attachment":[{"href":"https:\/\/allurebeautyandaesthetics.com.au\/paralowie\/wp-json\/wp\/v2\/media?parent=6583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}