Consultation

Step 1 of 4

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  To answer questions and give you the chance to get the very best results & convenience: there are a few short audio/video presentation clips which watching will really assist.
• Name*
  
  First
  
  Last
• Preferred name to be addressed by if different
• How should we address you?
  • 
    She/Her Ms
  • 
    He/Him Mr
  • 
    Them/They Mx
  • 
    Prefer not to say
• Date*
  
  DD slash MM slash YYYY
  
• Email*
  
  Enter Email
  
  Confirm Email
• Phone*
• Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Occupation
• What body/face areas are you coming for laser treatment on?*
• Where did you find out about Metro Laser Clinic?*
• Are you an emergency services/NHS employee or member of Glasglowgirls Club [Please indicate which]*
• Other than the patch test, Have you already purchased further sessions online?*YesNo
• How many sessions did you purchase if yes?
• Please tell us more if you've had Laser or IPL treatments before enter none if you haven't:*

• Your Health & Medications
• Please tell us of any medical conditions you have – if none type 'none'*
• Please tell us of any medications you are currently taking if none type 'none':*
• Transitioning Clients only: Hormones for transitioning – please give us more details of any hormone treatments and the duration to date to allow us to best assess the optimal laser energy
• Applicable Clients: Are you pregnant?*YesNo/Not applicacle
• Have you had any Covid vaccinations in the past six months – if so how many?*Yes 1Yes 2No/Not applicacleAllergy/Other prevents me getting one
• Have you used accutane/roaccutane or similar anti acne?*YesNot in the last yearNever
• Do you use oral anti-histamines for allergies?*YesNo
• Do you get cold sores on your lips?*YesNo
• Do you take St Johns Wort herbal supplements?*YesNo
• Do have Lupus?*YesNone of these conditionsSome of these
• Do have a light allergy?*YesNone of these conditionsSome of these
• Do have a history of cancer, keloid scars tendencies, auto immune conditions?*YesNone of these conditionsSome of these
• Have you taken anti acne medication (Accutane) in the last year?*YesNone of these conditionsSome of these
• Please confirm you have watched our info video*
  • 
    Yes I watched it
  • 
    No I haven’t
  • 
    Can’t access it

• Upload photo file for assessmentMax. file size: 128 MB.Should you wish to send us in a photo of hair to assess please upload with a clear image in good light. Out secure servers are encrypted and ultimatley secure.
• Have you a deep tan from a vacation in the last 4 weeks on the area to be treated or fake tan?*YesNo
• Do your skin type or facial features more resemble your Mother or Father?*
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    1 Mother
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    2 Father
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    3 Not sure
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• Your hair colour/type on the area to be lasered:*
  • 
    1 Powder blonde Blonde,Red, White, Grey
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    2 Light Blonde or Auburn
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    3 Light Brown/Mediterranean/Light Asian
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    4 Dark Brown/Dark Asian
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    5 Light Black
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    6 Black
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• Have you shaved, waxed, plucked, threaded or epilated the hair in the last 3 weeks on the area to be treated?*
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    1 Shaved
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    2 Waxed
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    3 Laser/IPL
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    4 Epliated with threading, electrolysis
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    5 Plucked
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    6 Veet or similar chemical epilation
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• Your skin colour/type*
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    1 Very Pale
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    2 Pale with beige tint
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    3 Light Brown/Mediterranean/Light Asian
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    4 Dark Brown/Dark Asian
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    5 Light Black
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    6 Black
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• Which ancestral country would you say you've inherited your skin type from?* Certain regions of the world have different reactions this helps us to know if there are specifics relating to you. i.e. Celtic/Nordic skin goes more flush and South Asian skin reacts its it’s own unique way.
• What happens when you stay too long in the sun?*
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    0 Painful redness, blistering, peeling
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    1 Blistering followed by peeling
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    2 Burns sometimes, followed by peeling
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    3 Rarely burn
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    4 Never burn
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• To what degree do you get browner?
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    0 Hardly or not at all
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    1 Light colout tan
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    2 Reasonable tan
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    3 Tan easily
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    4 Turn darker brown quickly
• Please tell us if you've had any of these treatments in the last 2 years on the area to be treated [enter 'none' for none] : Glycolic Acid (over the counter) Less than 10% Retin-A, Differin Renova, Adapin Sunburn Moderate peel Light peel Liposuction Dye laser Accutane (oral) Photoderm (spider veins) Implant surgery, Deep peel, Laser resurfacing , Burns, Surgical scars, Skin graft*
• Please tell us all facial products that you use if you're having face laser sessions:*enter ‘none’ if none
• Please tell us if you've had aesthetic treatments like botox, chemical peels, microdermabrasion of fillers on the area to be treated in the last month [enter 'none' if none]*enter ‘none’ if none
• Please tell us if you have any of the following and more about the condition: Diabetes, Keloid scarring, Thyroid condition, Melasma, Vitiligo, Pigmentation disorders, Epilepsy or anxiety disorders [Please type 'none' if none]*enter ‘none’ if none
• Are you photosensitive, taking St Johns Wort, have Lupus or on any medications which require you to stay out of the sun?*
  • 
    Yes
  • 
    No
  • 
    Not sure
  • 
    

• Almost there!
  Consent Form.
  Please type I agree where required to indicate you understand and consent to proceed.
• Consent* I agree to Laser Treatments at Metro and have read the terms.I authorise therapists of Metro Clinic to perform the laser treatment for hair removal using the Polaris Long Pulsed Nd:YAG Laser. I understand that they has been trained at the Polaris training academy under the guidance of a Qualified Laser Operations Trainer and have the standard required by Polaris to operate this equipment or have Advanced required Level 4 certification in Laser & Light . I understand that the laser treatment for unwanted hair with selected laser light at 1064nm has been shown in clinical studies to be a safe and effective alternative to methods used for removing unwanted hair such as shaving, waxing, chemical epilation and electrolysis. I have been specifically advised that: (When you have read and understood each section please initial) 1: The clinical evaluation of laser epilation is still ongoing but initial studies of patients treated in 1996 show arrest of hair growth in the treated area from time of initial treatment until current date. I have been correspondingly advised that the number of treatments and the length of each treatment can vary from person to person and is dictated by size of area, density of hair, colour of hair and colour of skin. I have been further advised that only hairs in their active growing stage can be successfully treated. For the above reasons I acknowledge that it is not possible to be entirely accurate in determining the number of treatments required to obtain permanent hair loss.
• Consent* I consent understanding about make up removal where applicable and rare pigmentation issues as described2: There is a risk of temporary hyperpigmentation (brown discoloration) or hypopigmentation (lightening of the skin). In very rare cases this may be permanent. 3: Exposure to the sun either directly before or after the treatment is not recommended. 4: To enable the laser to effectively remove all the growing hairs, it is possible but highly unlikely, that the light intensity may generate slight blistering of the skin that might cause temporary scabbing. These accepted conditions are known and recognised, and will resolve themselves in a relatively short time. No permanent marking is likely, although in rare cases marking may persist. Removal of make up and foundation is essential prior to treatment by clients receiving treatment to facial areas. 5: I acknowledge that I have been advised that on rare occasion’s hair removal by laser might not be successful. I agree to inform the practice if have any changes to medication or develop any medical conditions between appointments.
• Consent* I agree the conditions as outlined and understand I can ask any questions at the patch test.I have been fully informed of the nature and purpose of the procedure, expected outcome and possible complications. I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed with treatment is based solely on my expressed wish to do so. Due to operational reasons for laser maintenance Metro Clinic may have to reschedule your appointment. Clients are requested to give 24 hours notice when rescheduling, Metro Clinic will endeavour to re-allocate any cancelled appointments within this time to avoid the cancelled treatment being considered as part of any treatment plan. I have been given the opportunity to ask questions and hereby certify that I have read and fully understand the contents of this consent form before affixing my signature below. Should my medical condition or medications change during my treatments I agree it is my responsibility to inform Metro Laser Clinic. I also agree it is my responsibility to give adequate notice 24/48 hours cancellation as indicated or I will be invoiced for missed appointments at late notice that the clinic is unable to re-allocate.
• Consent* I agree to the Covid prevention policy.I understand I am required to comply with COVID restrictions and will not attend if I have been required to self isolate when an appointment is scheduled & will inform the clinic if I am currently experience sysmptoms to cancel my appointment & agree my temperature will be taken on arrival.
• Remember your mask before entry.
  You can also purchase plans from us cheaper than anywhere else and we appreciate if you refer friends direct to us.
  You’ll find a printed consent form that you need to initial and sign on arrival. You may reschedule appointments on our online booking system following the links at the bottom of the appointment email.
  The easiest way to contact us is on the clinic mobile by text 07739 479682 if you’re delayed etc.