Laser Consultation

Where * denotes a required field.

    Patient Profile

    Gender *

    Medical Assessment

    What laser treatment are you interested in?

    Have you ever been treated here before? *

    Do you have any serious health conditions? *

    Have you suffered from epileptic fits? *

    Do you have any allergies? *

    General Assessment

    Please tick the appropriate box below

    Your genetic background affects your skin and its response to the laser or IPL. Please specify your ethnic origin: *

    When you sunbathe how does your skin respond? *

    Have you sunbathed, used sunbeds or developed a tan darker than your usual skin colour (even from walking around or sitting in the sun) in the last 6 weeks? *

    Are you planning on a holiday soon? *

    Have you used self-tanning products in the last 3 weeks? *

    Do you have any implants, tattoos or permanent makeup in/on the area to be treated? *

    Have you ever used or had Renova or Retin A, Alpha hydroxyl, Glycolic Acid or other cosmetic peels? *

    Have you ever had Botox or fillers? *

    Have you ever had laser resurfacing procedures (particularly on the face)? *

    Are you wearing any kind of perfume in the area to be treated? *

    Have you ever had a skin problem or been under the care of a dermatologist? *

    Are you using AlumierMD/Cosmedix Skincare (or similar) on the area to be treated? *

    Are you on Skin Vitamin A or any Vitamin A product/tablets? *

    Do you take any medications, drugs or over the counter preparations/remedies? *

    e.g. Roaccutane, isotretinoin or other retinoids, St John's wort, Amiodarone, Minocycline, Minocin, Dianette (risk of hyperpig) or other contraceptive pill, any steroids, Warfarin or other protein Shakes / supplements. Also any photodynamic therapy (PDT) medication (e.g. Photofrin, Foscan, ALA or Metvix). Please note that patients on a daily aspirin therapy, iron supplements, anticoagulants or herbal supplements (e.g. gingko, garlic, ginseng) may bruise more readily. Patients should avoid aspirin or alcohol 48 hours prior to and 72 hours following laser treatment.

    Medical History

    To help give the best possible care, please carefully read and tick all that apply to you from the list below:

    Have you had any prior hospitalizations and surgery in the last 5 years? *

    Do you consent to us using your before & after photos? (your identity will be protected) *