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.

Venus Versa IPL Treatments Consent(Required)
Inner Beauty Concepts Acknowledgement & Consent(Required)
Media Consent (not applicable for bikini area clients)
Post Care Instructions(Required)
Do you have superficial metal or other implants in the treatment area?(Required)
Current or history of cancer, or current condition of any type of cancer, or pre-malignant moles?(Required)
Are you pregnant/and or nursing?(Required)
Do you have any conditions that are worsened by light exposure, such as Lupus, Porphyria, or Epilepsy?(Required)
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)
Do you have any poorly controlled hormonal or metabolic conditions, like Diabetes or PCOS (Polycystic Ovary Syndrome)?(Required)
Do you have any active conditions, such as sores, Psoriasis, eczema, and rash, in the treatment area?(Required)
Do you have a history of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin?(Required)
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)
Are you currently taking any medications that leave you sun sensitive?(Required)
Have you experienced excessively tanned skin from sun, tanning beds or tanning creams within the last two weeks?(Required)
Have you had any surgical procedures in the treatment area within the last three months or before complete healing?(Required)
Do you have any tattoos or permanent makeup in the treatment area?(Required)
Have you been diagnosed with Vitiligo?(Required)
Choose Your Fitzpatrick Skin Type(Required)