Red Light Therapy Waiver and Consent Form
Acknowledgment and Consent: I, the undersigned, hereby acknowledge that I have voluntarily chosen to undergo red light therapy at Haris Harini Lender Property. I understand that red light therapy involves the use of low-level wavelengths of light to promote healing, reduce inflammation, and improve skin conditions. While generally considered safe, I am aware that, as with any treatment, there are potential risks and side effects.
Risks and Side Effects:
Eye Damage: Red light therapy can cause eye strain or damage if proper eye protection is not used.
Skin Irritation: There is a risk of redness, rash, or irritation, particularly for individuals with sensitive skin.
Burns: Improper use or prolonged exposure may result in burns.
Photosensitivity: Some medications or health conditions may increase sensitivity to light, leading to adverse reactions.
Temporary Discomfort: Some users may experience discomfort, such as a feeling of warmth or slight pain during or after the session.
Unintended Effects: There may be other risks not currently known.
Medical Conditions and Medications: I confirm that I have informed Haris Harini Lender of any medical conditions, medications, or other treatments that could potentially affect or be affected by red light therapy, including but not limited to:
Photosensitivity disorders such as lupus
Photosensitizing medications such as lithium, melatonin, phenothiazine antipsychotics, tetracycline, doxycycline, hydrochlorothiazide, naproxen. If you are unsure about your medications, consult your pharmacist or prescribing physician.
Skin conditions
Autoimmune diseases
Pregnancy
Epilepsy or Seizures
Eye diseases such as diabetes, macular degeneration, or history of eye disease
Safety and Instructions: I agree to follow all safety instructions provided by Haris Harini Lender and to use any protective equipment as directed. I understand the importance of adhering to recommended exposure times and treatment protocols.
Release of Liability: By signing this waiver, I acknowledge that I have read and understood the information provided about red light therapy and its associated risks. I confirm that I do not have/take any of the contraindicated medical conditions or medications. I agree to release and hold harmless Haris Harini Lender, its staff, and affiliated entities from any liability, claims, or damages that may arise from my participation in red light therapy. I agree to indemnify and hold harmless Haris Harini Lender, her employees, agents, and affiliated entities from any and all claims, damages, or expenses, including attorney’s fees, arising out of my use of red light therapy.
Important: This waiver is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a healthcare provider for any health concerns or before starting any new treatment.
I acknowledge that Harris Harini lender is not a medical professional, and that I have done my own homework, and understand what red light therapy is and how to use it.
Participant Information:
Name:
Participant Phone Number:
Date of Birth:
Participant Email Address:
I have had the opportunity to ask questions and have received satisfactory answers regardingred light therapy and this waiver. I hereby consent to receive red light therapy and accept therisks involved.:
