Arnold D. Panzer, MD
Aesthetic Skin Care
986 Sunrise Highway
North Babylon, NY 11703
(631) 587-6060 fax: (631) 661-6358
Informed Consent for Laser Hair Removal
Patient Name: _________________________________________
I hereby authorize and direct any associates or assistants of Dr. Arnold Panzer to perform laser assisted hair removal
on me. I understand that this procedure works on the growing hairs and not on dormant hairs. For this reason,
complete destruction of all hair follicles from any one treatment is unlikely, and I understand that I will require several
treatments to obtain a significant, long-term reduction of hair growth. I also understand some people may not
experience complete hair loss even with multiple laser procedures.
The following points have been discussed with me:
The potential benefits of the proposed procedure.
The possible alternative procedures.
The probability of success.
The reasonably anticipated consequences if the procedure is not performed.
The most likely possible complications/risks involved with the proposed procedure and subsequent healing period,
including, but not limited to, infection, crusting, scarring, change in skin color, and/or blistering.
Post treatment instructions.
I am aware of the following possible experiences/risks with Laser Surgery.
• DISCOMFORT- Some discomfort may be experienced during laser treatment.
• WOUND HEALING- Laser Surgery can result in swelling, blistering, crusting, or flaking of the treated areas, which
may require one to three weeks to heal. Once the surface has healed, it may be pink or sensitive to the sun for an
additional two to four weeks, or longer in some patients.
BRUISING/SWELLING/INFECTION- With some lasers, bruising of the treated area may occur. Additionally, there
may be some swelling noted. Finally, skin infection is a possibility although rare, whenever a skin procedure