The Spectrum Intense Pulsed Light (IPL) is a device used for many aesthetic procedures. Depending on which treatment head is connected it can be used for the reduction of hyperpigmentation (brown/red discoloration), unwanted body hair, active acne and vascular lesions. 

I understand that the treatment may involve a series of treatments. Individual response will vary according to skin type, hair color, degree of tanning, follow up care, and the body area being treated. 

I understand that there is a possibility of rare side effects that consist of pain, reddening, buring, swelling, fragile skin, discoloration and temporary bruising of the skin. A crust or blistering may form, which may take 5-14 days to heal.  Color changes, such as hyper-pigmentation (brown/red discoloration) or hypo-pigmentation (skin lightening)  may occur following treatment.  The discoloration may take several months to resolve but in rare cases in can be permanent. Unprotected sun exposure in the weeks before and following treatments is contraindicated as may cause or worsen this condition.  A blue purple bruise (purpura) may appear on the treated area. This can last a couple of weeks up to several months to completely resolve. Scarring and burns can occur but is uncommon.  

• I authorize and consent to the treatment of Laser/IPL Spectrum System.

• I have been advised by Top Beauty Bar of the purported advantages and disadvantages associated with this treatment.

• I understand that treatment with this system varies from patient to patient and that more that 1-treatment may be required. Although rare, adverse outcomes such as hyperpigmentation and/or hypopigmentation (darkening or lightening of the skin), skin texture changes, and trace scarring can occur.

• No guarantees have been made to me regarding the outcome of the treatment or any improvements in my condition due to the procedure.

• I understand that the possible benefits are the reduction and possibly the elimination of the requested areas during my consultation.

• Due to the brilliance of the laser light energy used, I agree to wear eye protection to shield my eyes. I have been given the opportunity to ask questions and have received satisfactory answers to those questions.

• I understand and hold harmless Rohrer Aesthetics, Inc. and Top Beauty Bar from any all liability, damages, cost, and expenses arising from or out of the use of the Spectrum IPL Laser System.

I have read and acknowledge these requirements, of my procedure to better assist with treatment adversities that can occur if protocol is not taken seriously. I know that this is an elective service and my questions regarding services have been answered satisfactorily I understand this procedure and accept all risks and will notify TBB of any changes that could put my treatment at risk.

I have read, and acknowledge these requirements of the procedure.

Medical Waiver

I have read, and acknowledge these requirements, of my procedure to better assist with treatment adversities that can occur if a protocol is not taken seriously. I know that this is an elective service and my questions regarding services have been answered satisfactorily I understand this procedure and accept all risks and will notify Top Beauty Bar of any changes that could put my treatment at risk.

I take full liability and responsibility for all risks, undesired outcomes, or adverse events associated with the injections and will not hold the provider of Top Beauty Bar LLC liable for any unfavorable outcome or adverse event. I release Top Beauty Bar LLC, its owner, and medical staff from liability associated with the procedure. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors, and assigns. I hereby release Top Beauty Bar LLC, Tina Videtic, and staff from all liabilities associated with the indicated procedure. The procedures to be used to treat my condition have been explained to me. Any adverse reaction should be reported immediately to the office mobile at 920-678-7709.

I have read, and acknowledge these liability requirements of my procedure.