have given Dr. Zimmerman/Dr. Lee and his designate permission to preform Nd:YAG laser procedures on my face and body for hair/vasc/pigmented lesions.
The LightPod Neo™ (Nd:YAG 1064nm) laser is FDA approved for a variety of procedures including hair removal, vein treatment and wrinkle reduction. This form is designed to give you the information you need to make an informed choice of whether or not to undergo Nd:YAG laser treatment. If you have any questions at any time, please do not hesitate to ask. Although the laser treatment is effective in most cases, no guarantee can be made that a specific patient will benefit from the treatment(s).
The laser emits an intense beam of light that is absorbed in specific body tissues within the skin, and depending upon the type of procedure, several treatments may be required at intervals specified by the physician.
LACK OF TREATMENT RESPONSE
I consent to be photographed before, during, and after the treatment and that these photographs shall be the property of this office and may be published in scientific journals, used for education, and/or marketing reasons. Photographs will be masked and cropped to protect your identity.
I certify that I have read or have had read to me, the content of this form. I understand the risks and alternatives involved in this procedure. I have had the opportunity to ask any questions that I had and all of my questions have been answered.