I understand that the TheraLight360 Full Body Wellness System is a safe and non-invasive treatment and has been cleared by the FDA to emit photon energy for the relief of minor muscle and joint pain, muscle spasm, pain and stiffness associated with minor arthritis, promoting relaxation of muscle tissue and temporary increase in local blood circulation. I understand that every individual responds uniquely to light therapy treatments. Some patients may see immediate results or may require several treatments before they begin to feel results. Note: Occasionally some clients may experience mild fatigue, discomfort or aches after their first treatment. This is a normal healing phenomenon known as retracing. These responses should reduce after 24-48 hours, if they persist notify the technician prior to your next appointment

The TheraLight Full Body Photobiomodulation system uses LEDs (light emitting diodes) in the red (visible) and near-infrared (invisible) wavelengths of the electromagnetic spectrum. Since the TheraLight units do not emit ultravioletlight (UVA & UVB), and the light emitted is non-coherent (non-focused), the FDA and various regulatory agencies do not require users to wear eye protection. Although eye protection isn’t necessary, the lights are bright and may be uncomfortable for some individuals with sensitivities to light. For these individuals it is recommended that they do not look directly at the LEDs, and it may be most comfortable to close their eyes during a treatment session.

Some individuals may choose to wear eye protection if they experience the following:

• Pre-existing eye conditions of contraindications (check with your doctor)

• Pre-existing photosensitivity or photophobia (check with your doctor)

• Taking photo-sensitizing medications (check with your doctor)

• Certain medical conditions are more likely to react to light

• Bright or flashing lights can trigger migraine headaches or seizures in susceptible people

Summary: Protective eyewear that includes goggles, masks and glasses are not required for use during a TheraLight treatment sessions, unless indicated previously for individuals with specific conditions and upon request from their doctor.

 

More research is necessary to detect any potential adverse effects of PBM during pregnancy before PBM therapy can be utilized while pregnant.

More research is necessary to detect any potential adverse effects of PBM on cancer treatment outcomes before PBM therapy can be utilized in clients with active cancer diagnosis.

More research is necessary to detect any potential adverse effects of PBM on patients taking immune suppressant medications before PBM therapy can be utilized by these clients.

This does not include topical or oral medications.

If you answered yes to the above precaution Living Libations recommends that you do not participate in PBMTherapy at this time.

If you answered yes to the above precaution Living Libations recommends that you do not participate in PBMTherapy at this time.

In a small percentage of persons with seizure disorders, exposure to flashing lights at certain intensities or to certainvisual patterns can trigger seizures. If you answered yes to the above precaution Living Libations recommends that you do not participate in PBMTherapy at this time.

I have read and understand the foregoing: I understand the TheraLight360 Full Body Wellness System treatment I receive today is of my own choosing. This Therapy Consent Form applies to subsequent visits and treatments. I understand that there are no promises or guarantees regarding the results of the treatment and that to achieve maximum clinical results, I may need multiple treatments.

I hereby release, acquit, and forever discharge and hold harmless this business, and their past, present and future officers, directors, stockholders, attorneys, agents, servants, representatives, employees, corporations, subsidiaries,
affiliates, partners and partnerships, insureds, predecessors, and successors-in-interest and all other persons or entities for whose conduct it may be liable, of and from any and all claims, demands, damages, causes of action,
suits and liabilities, which may arise, known or unknown, now have or which may hereafter accrue, because of, arising out of or in any way connected with the services received from this business or their employees or agents.