Laser hair removal consent

By signing this form you can you confirm that you:

Have not taken oral acne medication in the last six months (Accutane/ Roaccutane);
Have not taken certain medication (as per medication sheets given) Botox, fillers, lifting thread;
Do not suffer from or have had photosensitivity, peels, resurfacing treatments;
Do not suffer from Auto Immune Disease, lupus HIV, Crohns, Colitis, hepatitis;
Have no organ problems;
Have no semi-permanent make-up in area, and tattoos;
Are not pregnant;
Do not suffer from epilepsy;
Have no active cold sores / herpes virus;
Have no keloid scarring;
Have no pace-maker or electrical implants;
Have no metal in treatment area;
Are not suffering from infectious disease;
Do not suffer from Haemophilia or Blood clots and varicose veins on upper legs;
Have no history of cancer / current cancer;
Have no tanned skin (real or fake);
Have no malignant or suspicious tissues, or are waiting for test results;
Do not have diabetes type 1 and uncontrolled 2;
Have no open wounds to area;
Do not have active eczema or psoriasis;
Do not have vitiligo;
Do not use St Johns Wort;
Are not taking any strong anti-inflammatory medication;
Are not under 18

You can also confirm that you are not currently taking any of the following medication: 

Isotretinoin
Tretinoin
Retin A
Roaccutane
Tetracycline
Cisplatin,
Chlorambucil,
Procarbazine,
Methotrexate,
Cytarabine,
Acetohexamide,
Trimeprazine,
Chlorpropamide (Insulase),
Tolazamide Tolbutamide,
Glimipiride,
Glipizide,
Glybuide,
Tolazimide (Tolinase),
Bupropion,
Clonipramine,
Desipramine Doxepin, Fluoxetine(Prozac),
Maprotiline Mirtazapine,
Notriptylin Paroxetine(Paxil),
Protriptyline,
Sertraline(Zoloft)

You can also confirm that you have not taken any of the below in the past 72 hours:

Astimizole,
Cetirizine,
Cyproheptadine, Diphenhydramine,
Claritin,
Terfenadine