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Valhalla Laser Hair Removal

Let us do this part
Today's Date:
Sat Jul 12 2025 06:37
VALHALLA LASER CLINIC
22 NELSON STREET
KILMARNOCK
KA1 1BD
Please read and answer
Y
N
Contraindications *
Please tick to confirm you;
DO NOT suffer from any of the following conditions or take any medication? If so, please advise prior to treatment;

Porphyria (light sensitive skin)
Psoriasis
Dark Moles*
Keloid/Hypertrophic Scarring
Skin Cancer
Tumours
Diabetes
Epilepsy
Haemophilia
Heart Conditions
Pregnant
Mental Impairment
Bloodborne pathogens
Transmittable diseases
Under the influence of drink/drugs
Tattoos*

* Moles/Tattoos in the treatment area will be avoided or covered

Details:
 
Hair Removal - Information & Reaction*
Please ensure you have shaved 24hours prior to your appointment


Reactions;

Common;
Swelling
Redness
Tenderness
Heat/Sunburn Feeling

Uncommon;
Histamine Reaction
Hives

Rare;
Burns
Blistering
Hypopigmentation


If you have any adverse reactions, please notify your technician as soon as possible
Hair Removal - Reduction*
75% reduction in hair is classed as successful

Unfortunately, hairs that are too thin or lack sufficient pigment ie. gray/white/vellus will be unaffected

Time between appointments is important, reduction will be affected if this is not adhered too.

Face: 4-6weeks
Body: 8-12weeks
IMPORTANT*
Please avoid;


6 weeks before for full duration:

* Waxing/Epilating/Tweezing


During course of treatment:

* Sunbeds


For 72hours minimum:

* Saunas
* Steamrooms
* Exercise
* Fragranced products
* Submerging area in hot water
* Sun exposure

Please note, factor 50 is recommended with all sun exposure
Questions*
I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the technician and clinic/studio
Photography*
I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your technician)
Waive*
TO WAIVE AND RELEASE to the fullest extent permitted by law the operator & studio/clinic from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from my laser, whether caused by the negligence or fault of either the operator or Studio/Clinic, or otherwise.
Payment*
Cash, Bank Transfer or Paypal is accepted

 
How did you hear about us??*
 
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Name:*
Address:
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


Physician Information
Enter your physician or medical practitioner's contact details or use our suggested default medical facility.
Name:
Contact:
Address:
Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.