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Health declaration form
Part 2 - LMS Clinic Staff Use

Customer Health Declaration - Part 2 (LMS Clinic Use)

To be completed by LMS Clinic staff only

The information I have given is correct to the best of my knowledge and I have not withheld any known medical condition. I will inform the laser operator before treatment if there has been any changes to my health (medication, pregnancy etc)

I understand that the results from this treatment vary considerably, and a small percentage of people will require more sessions to achieve satisfactory results.

I understand there is no guarantee of permanent results and maintenance treatments may be necessary.

I understand I must avoid sun exposure on the treated area for the duration of the treatment (and up to 1 month afterwards) or use a high sun protection factor to avoid sun damage.

I understand that there may be short-term side effects such as reddening or mild burning, hypo-pigmentation or hyper-pigmentation.

I understand that I must wear protective eye goggles during my treatment.

I agree that my contact details can be used to be kept updated about special offers and other information about LMS Clinic and its services that might be of interest.

I certify that I have read and understood all the information and my questions have been answered before signing this consent form. I consent to the terms of this agreement.

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