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Our Hours:

Mon: 9:00 am - 5:00 pm
Tues: 10:00 am - 7:00 pm
Wed: 9:00 am - 5:00 pm
Thurs: 10:00 am - 7:00 pm
Fri: 9:00 am - 5:00 pm
Sat: Closed
Sun: Closed

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Our Hours:

Mon: 9:00 am - 5:00 pm
Tues: 10:00 am - 7:00 pm
Wed: 9:00 am - 5:00 pm
Thurs: 10:00 am - 7:00 pm
Fri: 9:00 am - 5:00 pm
Sat: Closed
Sun: Closed

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Laser Hair Removal Contraindications

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Laser Hair Removal Contraindications

* indicates a required field

Please choose yes or no for each option

Lactation, Pregnant *

Yes
No

Self-Tanners, beach vacation or tanning, including tanning beds seven days before and seven days after treatment. *

Yes
No

Tattoos covering the full treatment area *

Yes
No

For face-use of Accutane in the last six month *

Yes
No

History of high blood pressure *

Yes
No

Cardiac pacemaker, defibrillator or electronic device/metallic implant *

Yes
No

Use of immunosuppressive medication (affecting the autoimmune system) *

Yes
No

Deterioration of the immune system (such as AIDS or HIV) *

Yes
No

Active or recent malignant pathology (cancer) *

Yes
No

Active or recent malignant pathology (cancer), use of anti-cancer drugs or precancerous lesions or suspicious moles *

Yes
No

Uncontrolled endocrine disorder (diabetes, thyroid, hormonal or polycystic ovaries) *

Yes
No

Hepatitis or liver disease *

Yes
No

Epilepsy *

Yes
No

Coagulopathy, excessive bleeding (hemorrhages), hematomas *

Yes
No

Use of anticoagulant medication *

Yes
No

History of deep vein thrombosis in the treatment area *

Yes
No

History of photosensitivity or use of medication that increases the photosensitivity of the skin between 6 months and 1 year prior to treatment, or herbs (St. Johns Wort) 2 weeks prior to the treatment. *

Yes
No

Vitiligo or a tendency towards hypopigmentation *

Yes
No

Tendency towards keloid formation or deterioration of the healing process. *

Yes
No

History or evidence of any chronic or recurring skin disease or disorder. *

Yes
No

Patient Signature *

By Signing above, I acknowledge that I have read all the details in the above consent form and will receive a copy of this form in email after it is signed.

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Patient Full Name *

Date *

Patient Email *

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About Us

Silver Solutions MedSpa, located in Pittsfield, MA excels at energizing your own inner and outer glow, with medical aesthetics while maintaining natural results. Based on your specific aesthetic goals, we design a customized treatment plan to help you look and feel your best.

Contact Info

The Central Block Building
75 North Street.
Pittsfield, MA 01201
Call 413.441.8453
office@silversolutionsmedspa.com

Working Hours:
Monday: 9:00 AM – 5:00 PM
Tuesday: 10:00 AM – 7:00 PM
Wednesday: 9:00 AM – 5:00 PM
Thursday: 10:00 AM – 7:00 PM
Friday: 9:00 AM – 5:00 PM
Saturday: Closed
Sunday: Closed

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