Hyperbaric Oxygen Therapy (HBOT) Consent & Overview

Red Light Therapy / Skin & Scalp 2.0 Consent Form

Red Light Therapy / Skin & Scalp 2.0 Consent Form

Patient & Provider Information

Patient Name
Patient Name
First Name
Last Name

Introduction / Purpose

Red Light Therapy (RLT) uses low-level wavelengths of red and near-infrared light to:

  • Promote skin rejuvenation and collagen production
  • Reduce inflammation and support tissue repair
  • Enhance scalp health and hair follicle stimulation
  • Improve circulation and overall cellular energy

Treatment Overview / How It Works

  • Light is delivered through LED panels or handheld devices at targeted areas
  • Typical session duration: 10–30 minutes, depending on treatment area
  • Frequency determined by provider based on condition and treatment goals

Contraindications & Warnings

Red Light Therapy may not be suitable for patients with:

  • Photosensitivity or sensitivity to light
  • Active skin infections, lesions, or open wounds at treatment area
  • History of skin cancer at treatment site
  • Use of photosensitizing medications or supplements

Precautions:

  • Patients should remove reflective or metallic jewelry
  • Avoid direct exposure to eyes; protective goggles may be used

Possible Risks / Side Effects

  • Mild: Temporary redness, warmth, or tingling at treatment site
  • Rare: Eye strain or irritation if protective measures are not used
  • Skin reactions are uncommon and usually resolve quickly

Pre-Treatment Instructions

  • Cleanse skin and remove makeup, oils, or topical products unless instructed otherwise
  • Avoid tanning or sunburn prior to session
  • Inform provider of any medications, supplements, or medical conditions

During Treatment

  • Patient is seated or lying comfortably under RLT device
  • Devices are calibrated and monitored to ensure proper wavelength and exposure
  • Patient may feel warmth or mild tingling, which is normal

Post-Treatment / Aftercare

  • No downtime; patients may resume normal activities immediately
  • Continue hydration and follow any topical or skincare recommendations
  • Contact provider if skin irritation, rash, or unexpected symptoms occur

Patient Responsibilities

  • Provide accurate medical history and disclose all medications and supplements
  • Follow pre- and post-treatment instructions
  • Report any adverse reactions or concerns promptly

Acknowledgment & Consent

  • I understand the purpose, risks, benefits, and alternatives of Red Light Therapy / Skin & Scalp 2.0
  • I voluntarily consent to undergo Red Light Therapy at AI Wellness Center of Excellence
  • I acknowledge that results may vary and no guarantees are made regarding outcomes
  • I release AI Wellness Center of Excellence, its providers, staff, and affiliates from liability, except in cases of gross negligence or willful misconduct

I consent to photographs, recordings, or data capture for medical documentation, education, or research if applicable