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Intake facial

Intake Facial (English)
  • The following questions are about your overall health and medical history. Please tick what applies.
  • Do you suffer or have you suffered from one or more of the following diseases?
  • I have answered all questions truthfully. It has been emphatically made clear to me that not answering the questions correctly or incompletely and not complying with the conditions can have a negative influence on the result of the treatment.

Informing consent

I hereby authorize the skin therapists at Gentle Skin Clinic to treat me with the Cynosure Elite+ laser and/or Cynosure Elite IQ laser in an attempt to reduce unwanted hair growth, fungal nails, vascular disorders or pigment disorders and/or treat pseudofolliculitis barbae.

I hereby confirm that we have discussed the nature of my condition, the treatment I wish to receive, any alternative methods, the general nature of the treatment proposed, the prospects for success and the potential risks and benefits of such treatment .

The procedure has been explained to me. The intended effect of the treatment is skin rejuvenation and skin tightening, removal of skin imperfections, tattoos or reduction of unwanted hair growth, of pigmentation spots, fungal nails or burst blood vessels. I have been informed that, despite the prospect of good results, the probability of complications and the nature of complications can never be precisely foreseen and therefore no guarantees, either express or implied, can be given as to the success or other outcomes of treatment.

I am aware that these treatments almost always have to be continued in the future in order to achieve and maintain optimal results. After laser hair removal on light or dark skin, there is a risk of paradoxical hair growth (increase of hair growth due to the heat in the skin, inactive hair follicles can be activated as a result). In exceptional cases, the laser therapy may not work (well), the cause could be a fluctuation in hormones. A small percentage of the population (3-9%) is a non-responder, the cause of this is unknown.

Laser hair removal of thick and dark hair on light skin gives the best results. With thinner hair and hair with less pigment (such as blond, gray and red hair), the treatments will be less effective. Depending on the treatment chosen, there are side effects such as swelling, tenderness, itching, irritation, scaling, redness and crusting. Risks are disappointing cosmetic results, longer lasting redness, and (temporary) pigment shifts. Although very uncommon, blistering, burning and even scarring may occur after treatment. I am aware that careful adherence to all advised instructions will help reduce this possibility.

With both lasers, avoidance of sunlight, the use of tanning beds, spray tans and tanning creams is necessary for at least 6 weeks before and 6 weeks after treatment. It is important to use good sun protection with at least SPF 50 several times a day. If this advice is not followed, there is a higher risk of blocked depigmentation, pigment shift, burning and scarring. Sauna visits, hot showers and/or intensive sports are not allowed 48 hours after the treatment.

I hereby declare that I have read (or been read to) this consent form and that I understand this form and the information it contains. I have had the opportunity to ask questions related to the treatment, including questions about risks or alternatives, and I declare that all my questions regarding the procedure have been satisfactorily answered. The points for attention after treatment have also been explained to me, and I will follow the advice given. I also declare that I have not withheld any information that could influence the result of the treatment.

I agree to be photographed if requested. These recordings are intended to be able to assess the result after treatment and are the property of Gentle Skin Clinic. Use of this for promotional purposes is excluded, unless I give express permission for this. For questions about the treatment or to report a complaint, I can contact Gentle Skin Clinic (

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