Client Forms | Inner Beauty Concepts

IPL Information and Consent Form

This consent packet provides information on the benefits and risks of Venus Versa™ IPL treatments. It also answers common questions about the procedure.

Name

Venus Versa IPL Treatments Consent(Required)

Venus Versa™ IPL Treatments

IPL for Skin Rejuvenation

IPL (Intense Pulsed Light) skin rejuvenation is one of the most effective treatments for reducing broken capillaries, rosacea, stubborn pigmentation, and sun-damage discoloration. It also delivers complementary benefits—improving fine lines, wrinkles, pore size, texture, and overall tone. Many clients notice clearer, more even skin throughout their treatment program.

How It Works
Using targeted light energy and specialized filters, IPL selectively targets redness, broken capillaries, brown spots, and sun-induced pigmentation while stimulating collagen in the dermis. This dual action helps dramatically even out skin tone while smoothing texture and refining pores.

What to Expect
• Performed by a Licensed Esthetician
• Non-invasive (no needles or surgery)
• Built-in cooling device for comfort
• Minor redness or swelling may occur, typically resolving within 1–2 days
• Makeup can be applied after 24 hours
• No downtime
• A customized skincare regimen will be recommended by your esthetician for best results

Consultation Detail
Before beginning, you’ll have a consultation to assess your skin type and goals. Your esthetician will customize a treatment plan, review costs and session duration, and determine the number of sessions needed, which can vary based on how your skin responds. A $35 consultation fee includes test spots and before-and-after photos to track your progress.

IPL for Hair Removal

IPL hair removal significantly reduces unwanted hair with minimal maintenance. It uses intense pulsed light to target and disable hair follicles through selective photothermolysis.

How it Works
The pigment in the hair follicle absorbs the light and converts it to heat, disabling the follicle and slowing regrowth. A cooling crystal built into the applicator enhances comfort and protects the skin.

What to Expect
• Mild redness or swelling may occur (resolves within 1–2 days)
• Lotion can be applied immediately
• Makeup on the face or sunscreen on the body can be applied after 24 hours
• No downtime
• Maintenance plan of additional treatments may be recommended for long-term results

Consultation Details
A consultation is required to evaluate your skin type, hair concerns, and goals. Your esthetician will outline your personalized treatment plan, session length, pricing, and the number of sessions needed, which may vary depending on how your skin responds. The $35 consultation fee includes test spots and, when appropriate, before-and-after photos (bikini area excluded).

Risks Associated with Venus Versa™ IPL Treatments

Complications from IPL are rare, and we have never seen these issues occur at our spa, but it’s still important to understand that they are possible.

Photosensitivity: Skin is sensitive to sunlight for 48 hours post-treatment. Sun exposure can cause redness, swelling, blisters, pigment changes, or—in rare cases, if not properly cared for—scarring.

Skin Wounds: Very rare but slightly more common on darker skin types or when aftercare isn’t followed. Typically heal in 5–10 days. May cause temporary or permanent pigment changes or, very rarely, scarring.

Pigment Changes: Temporary hyperpigmentation or hypopigmentation occurs in under 1% of cases and usually resolves. Permanent changes are extremely rare.

Tanning: Avoid tanning before and after treatment. Wait at least 6 weeks after tanning.

Bruising: Extremely rare; we have never seen this occur in our practice. If it were to happen, it typically fades within 8–10 days and may cause temporary hyperpigmentation.

Infection: Extremely unlikely since IPL doesn’t break the skin.

Excessive Redness & Swelling: Usually resolves within hours; rarely up to 2 days. Makeup may be used to cover it.

Fragile Skin (Facial Services): Peeling or blister-like reactions may occur if post-care instructions aren't followed; typically heals in 8–10 days.

Viral Susceptibility: Clients prone to cold sores may require their antiviral medication, or requesting an antiviral medication from their doctor.

Isotretinoin Use: Stop Isotretinoin (Accutane/Roaccutane) at least 3 months before treatment.

Treatment Expectations & Maintenance

Skin Rejuvenation Results
Most clients see a 40–70% improvement, though results vary.

Hair Removal Results
Many clients see reduction after the first session, but individual responses vary. Photos help track progress.

Maintenance

Some clients choose to continue IPL treatments seasonally—every 3 months for skin rejuvenation or every 3–6 months for hair removal—as new hair follicles grow or skin changes over time. Your esthetician will help you create a plan that feels right for you and schedule sessions during your final treatment if desired.

I understand and acknowledge the risks of Venus Versa™ IPL Treatments.

Inner Beauty Concepts Acknowledgement & Consent(Required)

Acknowledgement & Consent

By signing below, I understand and agree to the following:

1. Authorization
I give Inner Beauty Concepts permission to perform IPL treatments.

2. Flexibility During Treatment
I understand that unforeseen issues may arise, and I allow the provider to adjust or perform additional treatments as needed based on professional judgment.

3. Peer Review
I understand that my treatment chart may be reviewed by other professionals as part of quality assurance.

4. Results
I acknowledge that no specific outcome is guaranteed.

5. Photography & Video
I consent to photos or videos of my treatment for medical, educational, or promotional purposes, as long as my identity remains confidential.

6. Understanding the Treatment
Inner Beauty Concepts has explained:
• The treatment being performed
• Risks associated with the treatment
• Answers to all of my questions

Financial Policy
No refunds are given after a treatment is performed.

Series payments must be made in advance.

Disclaimer
This document explains the treatment and main risks, but may not include every possible risk or alternative.

Treatment standards may change with new scientific or technological advances.

I consent to the procedure and/or treatment and the above listed items.

Media Consent (not applicable for bikini area clients)

Media Release – Venus Versa™ IPL Treatments

By signing below, I understand and agree to the following:

1. Authorization
I allow Inner Beauty Concepts to take photos or written testimonials (“Media”) during my treatments.

2. Use of Media
I consent to the use of this Media for educational, marketing, or promotional purposes, including print, internet, and TV.

3. Ownership
I understand that all Media belongs to Inner Beauty Concepts, and I will not claim any rights or compensation unless agreed to in writing.

4. Approval
I waive any right to review or approve the Media or how it is used.

5. Privacy
My name will not be included, and my eyes will be blurred in all Media.

6. Legal Binding
This agreement applies to my heirs, legal representatives, and to Inner Beauty Concepts’ successors or affiliates.

7. Age
I confirm I am 18 or older, or that this form has been signed by a parent or guardian.

8. Legal Rights
I understand I can seek independent legal advice before signing.

9. Governing Law
This agreement is governed by the laws of New Hampshire.

By checking this box, you give permission for photographs and written testimonials to be taken and used as outlined above. Please review carefully.

Post Care Instructions(Required)

IPL Post-Care Instructions (Days 1–7)

Healing varies for each person. Here’s what to expect and how to care for your skin:

Hair Removal: Redness and swelling may last 5–7 days, sometimes with itching.
Pigment Treatments: Treated areas may darken, crust, or flake, with redness resolving in 3–7 days.
Vascular Lesions: Vessels may turn grey, purple, or black as they heal, usually for 3–7 days.
Acne Treatments: Lesions may darken, feel tender, and have redness/swelling for 5–10 days.

General Care: Mild redness or swelling may occur for 24–48 hours. Avoid hot baths, saunas, Jacuzzis, and pools for 2 days. A gentle moisturizer can be applied immediately after the treatment, and a sunscreen with SPF of 30+ should be used daily after the first 24 hours. Makeup can be applied after 24 hours but remove it before bed.

Contact Us: Call if swelling worsens after 24–36 hours or if redness spreads beyond the treated area.

I have reviewed and understood the Venus Versa™ IPL post-care instructions. I acknowledge that not following these instructions may affect my outcome.

Do you have superficial metal or other implants in the treatment area?(Required)

Yes

Current or history of cancer, or current condition of any type of cancer, or pre-malignant moles?(Required)

Yes

Are you pregnant/and or nursing?(Required)

Yes

Do you have any conditions that are worsened by light exposure, such as Lupus, Porphyria, or Epilepsy?(Required)

Yes

Do you have a history of heat-sensitive conditions like cold sores (Herpes Simplex) in the treatment area? Note: you will need to request treatment from your doctor.(Required)

Yes

Do you have any poorly controlled hormonal or metabolic conditions, like Diabetes or PCOS (Polycystic Ovary Syndrome)?(Required)

Yes

Do you have any active conditions, such as sores, Psoriasis, eczema, and rash, in the treatment area?(Required)

Yes

Do you have a history of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin?(Required)

Yes

Have you used any medications or supplements in the last 2 weeks that make your skin sensitive to light, such as Accutane, Tetracyclines, or St. John’s Wort?(Required)

Yes

Are you currently taking any medications that leave you sun sensitive?(Required)

Yes

Have you experienced excessively tanned skin from sun, tanning beds or tanning creams within the last two weeks?(Required)

Yes

Have you had any surgical procedures in the treatment area within the last three months or before complete healing?(Required)

Yes

Do you have any tattoos or permanent makeup in the treatment area?(Required)

Yes

Have you been diagnosed with Vitiligo?(Required)

Yes

Choose Your Fitzpatrick Skin Type(Required)

Find your Fitzpatrick Skin Type here

Type I

Type II

Type III

Type IV

Type V - VI

Type your full name to digitally sign this form.(Required)

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