Name *

First Name

Last Name

Phone *

(###)

###

####

Skin Type *

When exposed to the sun, select all that apply

always burns, never tans

always burns, sometimes tans

sometimes burns, sometimes tans

always tans

Artificial Tans *

If you've had an artificial tan in the last 3 weeks you are not eligible for Laser Hair Removal until the tan is gone. Legit your skin will turn black if I laser over this artificial tan. Just a FYI

I do not have a artificial tan

What areas are of concern that we are treating today? *

Please select all that apply

Full Face

Some areas of Face

Ears

Neck

Beard Line Up

Full Arms

Half Arms

Underarms

Full Legs

Half Legs

Toes & Feet

Full Back

Full Front (Chest & Abs)

Chest Only

Shoulders

Abs Only

Bikini

Brazilian

Medical History

Have you ever had the following:

Current or history of cancer, especially malignant melanoma or recurrent non melanoma skin cancer or precancerous lesions such as multiple dysplastic nevi

Any active infection

Diseases which may be stimulated by light, such as a history of recurrent Herpes Simplex, Systemic Lupus, Erythematosus, or Porphyria

Use of photosensitive medication and/or herbs that may cause sensitivity to light exposure, such as Isotretinoin, tetracycline or St. John's Wort

Immunosuppressive diseases including AIDS or HIV infection, or use of immunosuppressive medications

Patient History of Horomonal or endocrine disorders such as polycystic ovary syndrome or diabetes, unless under control

History of bleeding coagulopathies or use of anticoagulants

History of keloid scarring

Very dry skin

Exposure to sun or artificial tanning during the 3-4 weeks prior to treatment

Are you pregnant or nursing? *

Yes

No

Media Consent for Patient Files *

I understand that my technician/therapist will be taking photographs and video recordings, before, during, and/or after my procedure for my own patient file.

I agree

Media Consent for Marketing Purposes *

I give permission for my technician/therapist to take photographs and video recordings, before, during, and/or after my procedure. I give permission for my photos to be used on the company social media channels, website and used for any other marketing purpose. I further understand that there will be no financial remuneration for this.

Yes

No thank you

I understand that this consent is for today's treatment and all future treatments received at Unfiltered Beauty *

I understand

Procedure Consent & Client Responsibility *

I authorize Attajaan Ramji of Unfiltered Beauty to perform Laser Hair Removal using the Soprano Ice Platinum system. I understand that this device is used to reduce unwanted hair and that results may vary depending on individual factors such as skin and hair type, medical history, and compliance with pre- and post-care instructions. I acknowledge that short-term effects may include redness, swelling, blistering, temporary discoloration, or bruising, and while rare, complications such as scarring or permanent pigment changes can occur. I understand that this procedure typically requires a series of 6 to 10 sessions, and that maintenance treatments may be needed to sustain results. I confirm that I am not pregnant, I do not have a pacemaker or internal defibrillator, and I have not taken Accutane in the past 6 months. I understand that Laser Hair Removal is a cosmetic treatment and I am choosing to proceed voluntarily. I acknowledge that no guarantee has been made regarding the outcome, and I fully assume all risks. I have had the opportunity to ask questions and confirm that I understand the nature of the procedure, the potential risks, and my responsibilities as a client. I agree to follow all aftercare instructions provided by Unfiltered Beauty and accept full responsibility for the results of my treatment.

I agree

Late Arrival Policy *

At Unfiltered Beauty, each appointment is carefully reserved to ensure you receive the full attention and service you deserve If you arrive a few minutes late, a one-time grace period will be offered. If you are 10 minutes late to any future appointments, a $25 late fee will apply. If you arrive 15–20 minutes late and I am still able to accommodate you:
 • Your service time will be shortened to stay on schedule
 • A $75 extended time fee will automatically apply for appointments longer than 1 hour If you arrive more than 20 minutes late, your appointment will be cancelled and you will be charged 50% of the full service cost. 
To rebook, you must pay the full cost of a new appointment. These charges apply regardless of the reason — including traffic, parking, or difficulty finding the studio — as appointment slots are booked exclusively for each client. Thank you for understanding and respecting my time and the commitment I make to every client!

I understand & I agree

Rescheduling Policy *

At Unfiltered Beauty, appointment times are thoughtfully reserved just for you. To reschedule your appointment, I require a minimum of 7 days’ notice. This allows me to offer your spot to another client and maintain a smooth booking experience for everyone. If you request to reschedule with less than 7 days’ notice, a rebooking fee will apply. If you request to reschedule with less than 48 hours' notice, you will be charged 50% of your original service. To secure a new time slot, you’ll be asked to pay the rebooking fee or full amount upfront, depending on the timing of the change. These policies apply regardless of the reason for rescheduling, including work conflicts, illness, transportation issues, or weather, as each appointment is carefully scheduled in advance. Thank you for valuing the time and care that goes into preparing for your service.

I understand & I agree

Date

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