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Laser Tattoo Removal

Let us do this part
Today's Date:
Thu Nov 14 2024 03:19
Vancouver Tattoo Removal
Please read and answer
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COVID-19*
Have you tested positive or have you been in contact with anyone who has tested positive with COVID-19
Details:
 
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Sickness*
Have you had any symptoms of a cold or flu such as a fever, cough, sneezing, runny nose, sore throat, fatigue, OR have been in contact with anyone who has had those symptoms?
Follow up*
You agree to follow up VIA phone or email, if you experience any symptoms of COVID-19 within 14 days of visiting our studio.
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Do you have any chronic medical conditions we should know about?
Details:
 
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Do you have any allergies to medications, herbal, or natural supplements?
Details:
 
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N
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Are you allergic to red dye or shellfish?
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N
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Have you taken Accutane or any anticoagulants in the past 6 months?
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Do you have a history of Hypo/Hyper-pigmentation?
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Do you have a history of keloid scarring?
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Are you pregnant or nursing?
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Have you have ANY sun exposure in the past 4-6 weeks, including tanning beds, bronzing creams, or spray on tan?
 
Tattoos*
Where on your body and how old is tattoo(s) you would like to be treated?


 
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Do you have, or have you ever had any of the following:*
Poorly controlled Diabetes Mellitus
Thrombocytopenia
Peripheral Vascular Disease
Anemia
Bleeding Disorders
Rheumatoid Arthritis
Subnormal Intelligence or Psychiatric Disorders
History of Post-Inflammatory Hyper-Pigmentation
Chronic Disease (i.e. Crohn's, IBD, etc.)
Cellulitis
Psoriasis
Lichen Planus
Lichen Nitidus
Renal Failure
Malignancy
Multiple Sclerosis
Vitiligo
Immunosuppression
Keloids
Collagen Vascular disease
Details:
 
Laser Tattoo Removal Consent*
This form is designed to give you the information needed to make an informed choice to have laser tattoo removal. Although laser tattoo removal is effective in most cases, no guarantees can be made that you will benefit from the treatment. I understand that several treatments may be needed to obtain the desired level of improvement. Tattoo removal is done in stages. Sessions are spaced at a MINIMUM of 6 weeks apart. A longer wait time may be advised based on your tattoo and on the technicians recommendation.

The tattoo(s) may not completely come out, some will just lighten. Tattoos can even darken (though that is rare).

Black ink fades the fastest, though some black ink will be mixed with green and purple to darken. In this case, these colours will take longer to fade. Teal green is the hardest to fade.

Tattoos lay in your dermis, which is under your epidermis, and the laser is able to break through and fragment the colour to have it pass through your hypodermis. Your body will see these fragmented ink particles as foreign to the body and will send in white blood cells to eliminate them naturally. The degree of fading and the amount of treatments needed are dependant on your body chemistry. The procedure is painful!

Smoking or having certain health problems will prolong the treatment; drinking lots of water will help.

The most common side effects:

After treatment you may experience swelling, redness, bruising, blisters, pain or itching.

The snapping sensation of each pulse may produce a moderate amount of discomfort. You will be asked to keep the tattoo cool for a minimum of 24 hours after the treatment.

If you blister, DO NOT pop your blisters! Apply Polysporin (available at any drug store) liberally to the effected area. It is not unusual to see a large amount of colour come off with your blister.

If you swell or feel heat, apply ice to the area.

Infections are not common, but can happen. If you experience fevers, crusting, or extreme pain, please use a topical antibiotic and see a doctor.

Hyper-Pigmentation (skin darkening) and Hypo-Pigmentation (skin lightning) may occur in the treated area. In most cases the skin will return to its original state over time.

It is very important to stay out of the sun during your removal sessions. If you are in the sun, please use a high SPF sunscreen. If you tan in a booth, cover the treated area.

Allergic reactions: Though this is extremely rare, some may be allergic to the ointment applied post treatment. Please let your technician know of any known allergies.

Please be aware that there's a chance of some scarring from the trauma to the skin.
Vancouver Tattoo Removal- Release of Claims*
By providing my signature below, I acknowledge that I have read and understood that all tattoo removal results are unique, and the treatment may or may not work on every person, including myself. My body chemistry will determine my results. I understand that there are no guarantees.

I feel that I have been adequately informed regarding my tattoo removal.

I understand that there is a risk of scarring and skin discolouration as a result of the laser tattoo removal procedure.

I hereby freely consent to laser tattoo removal and am willing to have it preformed on me. I also consent to any photos taken of me to be used to record my progress, or with further verbalized consent, used for examples.

I agree to release and forever discharge and hold harmless the Laser Operator, 1245794 B.C. Ltd. dba Vancouver Tattoo Removal (and all of its employees and directors) from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo removal procedure.
A photo of your tattoo
At the bottom of this form you will be asked to take a photo of your ID. This section should be used to capture a clear photo of the tattoo you would like removed (instead of your ID) so we can track your progress :)
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


Photo ID
Please take photo(s) of your government issued photo IDs and related paperwork.