• I hereby authorize Dr. George Kamajian or any delegated, qualified, staff member to perform:I understand and agree that the total cost to me for this procedure is $____________ and that once treatments begin,there are no refunds. I also have read and signed the Financial Policy Form provided to me which explains my financial responsibility for this procedure.I wish to receive treatment on the following:
  • I wish to receive treatment on the following:

    Please specify area(s)

  • Please select and initial next to the treatment type you are interested in:

  • Please initial
  • Please initial
  • Please initial
  • Please initial
  • Your laser treatment is part of an overall medical and/or cosmetic regimen. Maximum success is based on compliance with all of our recommendations including medication, changes in lifestyle and sun exposure. The final result of any cosmetic procedure is subjective. Aging is a progressive physiologic state. Most treatment programs offered involve set fixed intervals.

    By signing below, I acknowledge and understand that the following topics have been discussed with me prior to any procedure being performed:

    Potential benefits of the proposed procedure

    Probability of success

    Reasonably anticipated consequences if the procedure is not performed, if any

    Possible Post-Procedure Experiences and Risks and subsequent healing period

    Post-treatment instructions

    Pregnancy status
    o By signing below, I hereby indicate that I am not pregnant.

  • BY SIGNING BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE INFORMATION REGARDING THE PROCEDURE I WISH TO BE PERFORMED AND AFTER CAREFUL CONSIDERATION, I WISH TO PROCEED AT MY OWN RISK. I HEREBY AUTHORIZE DR. GEORGE KAMAJIAN AND OR HIS DESIGNATED STAFF TO PROCEED AS OF THE EFFECTIVE DATE NOTED BELOW WITH ANY AND ALL PROCEDURES AS NECESSARY AND UNTIL TREATMENT IS ARE CEASED AND OR COMPLETED.

  • Pre Treatment Instructions

    • Please arrive 15 minutes prior to scheduled appointment for paperwork.
    • We will not be able to treat you if you have an active cold sore. It is advised that you pre-medicate one day prior to treatment to prevent any possible breakouts.
    • It is required that you do not take antibiotics 3 days prior to and 3 days post treatment. If you are on an antibiotic regimen, please call us at least 24 hours in advance to reschedule.
    • Avoid sun exposure, tanning beds, and tanning creams at least 2 weeks prior treatment, or we will not treat you. Instead, use at least an SPF 30 sunscreen.
    • Acne patients having used Accutane should have discontinued the use of it for at least 6 months prior to laser treatments.
    • Wear loose, comfortable clothing that will not rub the treatment area.
    • Please inform our staff before treatment if you have a history of hyper/hypo-pigmentation or inflammation, scarring, or have sensitive skin.

    Post Treatment Instructions

    • Avoid sun exposure for 1 week after your treatment.
    • The treated area may be flaky or appear speckled for a few days.
    • Avoid using irritating products like Retin-A, exfoliants, astringents, alcohol, etc. for at least 24 hours if redness or irritation of the skin is observed.
    • Apply cold compress to area if it feels hot after your treatment. Aloe Vera 1% Hydrocortisone applied for any irritation can be effective.
    • If blistering occurs, apply antibiotic ointment such a Bacitracin and cover with a nonstick bandage until the wound is healed. Call the office immediately. Do not rupture or pick at the blisters.