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Patient Consent for IPL Photofacial

Patient Consent for IPL Photofacial 2026

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The document is a patient consent form for IPL/Photofacial treatment at Lexington Family Medicine. It outlines the procedure, its purpose, contraindications, potential side effects, and post-treatment care instructions. The treatment aims to address various benign skin conditions through a series of sessions, and patients must acknowledge understanding the associated risks and agree to comply with care guidelines.

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Click ‘Get Form’ to open the Patient Consent for IPL Photofacial in the editor.
Begin by entering your name in the designated field where it states '_________'. This identifies you as the patient consenting to the treatment.
Review the information provided about IPL/Photofacial, including its purpose and potential side effects. Ensure you understand each point before proceeding.
Sign the form in the 'Patient Signature' section. This confirms your consent and understanding of the treatment.
Fill in the date of signing next to your signature to document when consent was given.
Print your name clearly in the 'Printed Name' section to ensure clarity on who is providing consent.
If applicable, have a witness sign in the designated area, confirming that they observed your consent process.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who cannot have an IPL?

Answer: What skin type is inappropriate for IPL? The only skin type that cannot be treated with IPL is type VI. The most important factor in the safety and effectiveness of the procedure is to do accurate skin typing of the patient, not just by visual inspection but by a thorough history and questionnaire.

Who should avoid IPL treatments?

Because IPL targets pigment, those with tanned or darker skin tones are NOT candidates for treatment. Those who have an active breakout or infection at the desired treatment area may not be treated.

Who is not a good candidate for IPL?

IPL is safe for most people but is not suitable for everyone. Pregnant women and people who are on blood thinners, for example, should avoid IPL. Other factors that make people unsuitable for IPL treatment include: currently or recently taking the acne drug .

What are the rules for IPL laser treatment?

What to do before your Lumecca IPL treatment Avoid sun exposure. Time your aesthetic treatments. Stop using harsh skincare products. Keep your face bare. Protect your skin from the sun. Moisturize your skin. Avoid makeup for 24 hours. Avoid heat.

Who should not get an IPL photofacial?

IPL treatment, or intense pulsed light therapy, is a cosmetic procedure to improve the skins texture.

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What is the protocol for IPL treatment?

Individuals with tanned or naturally dark skin are not usually candidates for IPL photofacial treatments. Individuals with darker skin sometimes experience changes in skin pigmentation after IPL photofacial treatment.

Patient Consent for IPL Photofacial 2026

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