» Laser IPL Treatment form

Laser IPL Treatment

CLIENT INTAKE FORM

Select Treatment Type

Client Information

Treatment Description

Intense Pulsed Light (IPL) is a non-invasive treatment that uses broad-spectrum light to target various skin concerns such as hair follicles, pigmentation, vascular lesions, and acne. The light penetrates below the skin's surface to treat imperfections and stimulate collagen production. A series of treatments may be needed for optimal results.

Medical History

Do you currently have or have had any of the following?

Risks & Side Effects

I understand that while IPL treatments are safe and effective, possible side effects include:

  • Redness, swelling, or sensitivity
  • Itchiness or irritation
  • Temporary darkening of spots or light crusting
  • Hyperpigmentation or hypopigmentation
  • Burns, blistering, or scarring (rare)
  • Acne flare-up (for acne treatment)

Before & Aftercare Instructions

**Before Treatment:**

  • Shave the treatment area 24 hours before your session (for hair removal)
  • Avoid tanning, waxing, or chemical peels 2 weeks before treatment
  • Discontinue use of Retinol or photosensitizing products 3-5 days prior
  • Ensure the treatment area is clean, dry, and free from lotions or deodorant

**After Treatment:**

  • Avoid direct sun exposure and apply SPF 30+ daily
  • Do not pick, rub, or scratch treated skin
  • Avoid heat, saunas, and intense activity for 24-48 hours
  • Do not wax or pluck hair during IPL hair removal course
  • Avoid biotin supplements or hair growth stimulants during treatment period

Photo/Media Consent

I give TR BEAUTY SPA permission to take photos/videos of my treatment area for:

Consent & Release

  • I confirm that the information I provided is accurate.
  • I understand the treatment, risks, and post-care requirements.
  • I release TR BEAUTY SPA and staff from any liability due to reactions caused by undisclosed conditions or failure to follow instructions.
  • I understand that no refunds will be issued for treatments already completed.
  • I acknowledge that stopping treatment midway may affect results and no guarantees are made.
  • I have read this form thoroughly, had an opportunity to ask questions, and agree voluntarily to proceed.

I understand that TR• Beauty Spa is committed to providing safe, professional, and individualized treatments using appropriate techniques and medical-grade technologies. I acknowledge that treatment outcomes vary between individuals and depend on factors beyond the control of TR• Beauty Spa, including my skin condition, medical history, lifestyle, healing response, and compliance with aftercare instructions. Therefore, no specific result or degree of improvement can be guaranteed. I understand that an outcome different from my expectations does not, by itself, indicate negligence or improper treatment. All treatments and packages are Final Sale and non-refundable, except where required by applicable law.

By signing below, I confirm that I have read and understood the information provided, and I willingly consent to undergo the specified Laser IPL treatment at TR.beautyspa.

Client Signature

Please sign in the box below

Treatment Session Log

Please fill in the following table with the date and notes for each session.

Session Date Notes
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session 10
Session 11
Session 12
Session 13
Session 14
Session 15
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