Laser Treatment Consent Form

Personal Information
Contact Details
Emergency Contact
Medical / History Data

Do you have any of the following conditions?

Are you wearing contact lenses?

Are you pregnant, breastfeeding, or nursing?

Medical & Skin Information
1. INFORMED CONSENT
I voluntarily request and consent to receive laser hair removal treatments. I understand that laser procedures involve concentrated light energy and may result in side effects including, but not limited to, redness, swelling, burns, blistering, pigmentation changes (hyperpigmentation or hypopigmentation), scarring, allergic reactions, or infection.

I acknowledge that results are not guaranteed, vary by individual, and may require multiple sessions.
2. MEDICAL DISCLOSURE & ACKNOWLEDGMENT
I certify that I have fully disclosed all relevant medical history, conditions, medications, pregnancy status, skin sensitivities, and prior treatments. I understand that failure to provide accurate information may increase the risk of adverse effects and releases the provider from responsibility.

I confirm that I am not receiving laser treatment against medical advice.
3. ASSUMPTION OF RISK
I knowingly and voluntarily assume all risks, known and unknown, associated with laser hair removal treatments, including those arising from ordinary negligence, equipment malfunction, or human error, to the fullest extent permitted under Texas law.
4. RELEASE & WAIVER OF LIABILITY (TEXAS)
In consideration for receiving laser hair removal services, I hereby release, waive, discharge, and agree to hold harmless Kley, the business entity, owners, operators, employees, contractors, and affiliates from any and all claims, demands, damages, injuries, losses, costs, or causes of action, whether known or unknown, arising out of or related to the laser hair removal services provided.

This waiver includes claims based on ordinary negligence under Texas law.
5. NO DISPUTE / NO REFUND / NO CHARGEBACK
I acknowledge that laser hair removal is an elective cosmetic procedure. I agree that once services are rendered, I waive the right to refunds, chargebacks, payment disputes, or claims related to dissatisfaction with results, discomfort, or expectations.
6. DISPUTE RESOLUTION & ARBITRATION (TEXAS)
Any dispute, claim, or controversy arising from this agreement or services provided shall be resolved exclusively through binding arbitration in the State of Texas, and not in court. I waive the right to a jury trial.
7. PHOTO & RECORD CONSENT
I authorize photographs and records to be taken for documentation, medical records, and internal use.
8. ELECTRONIC SIGNATURE & AGREEMENT
I acknowledge that I have read and understand this agreement in full, had the opportunity to ask questions, am signing voluntarily, and understand that this agreement is legally binding and enforceable under Texas law.

This consent applies to all future laser treatments unless revoked in writing.
9. GOVERNING LAW
This agreement shall be governed by and interpreted in accordance with the laws of the State of Texas.
Client Signature
Provider / Representative