- Individuals with active infections, open lesions, hives, herpetic lesions, cold sores, or tattoos and permanent make-up in the area of treatment should not undergo Laser Light Therapy.
- People who have used isotretinoin (commonly known as Accutane), tetracycline, St. John's Wort, or any photo sensitizing drugs in the last year should not undergo Laser Light Therapy. Vitiligo condition patients should not undergo Laser Light Therapy.
- Individuals with autoimmune diseases such as Lupus and Scleroderma should not undergo Laser Light Therapy.
- Individuals who have pacemakers or other electro-stimulation devices should not undergo Laser Light therapy.
- Insulin dependent should consult a physician undergoing Laser Light Therapy.
- Individuals with a history of melanoma, raised moles, suspicious lesions, keloid scar formation, or healing problems should not undergo Laser Light Therapy.
- Immune system dysfunctions such as leukemia, Hemophilia, etc., and light sensitive persons should not use the Laser Light device.
- During pregnancy, the individual should not undergo Laser Light Therapy. Nursing mothers should pump and dump before and after each Laser Light Session.
- Hypertension, light sensitive epilepsy, cancer (within the last 6 months), heart disease, infectious skin disease, and severe varicose veins should not undergo Light Laser Therapy.
- Infectious & acute diseases such as fever should not undergo Laser Light Therapy.
- Hemorrhagic disease, vascular ruptures, skin inflammation, or any disease of the skin should not use the Laser Light device.
I authorize the Invisared Therapist or Assistant, to help me in my weight reduction efforts. I understand that my program may consist of a balanced deficit diet, a regular exercise program, instruction in behavioral modification techniques, and may involve the use of appetite suppressant medications. Other treatment options may include a very low caloric diet, or a protein supplemented diet. I further understand that if appetite suppressants are prescribed, they may be used for durations exceeding those recommended in the medication package insert. It has been explained to me to my complete satisfaction that these medications have been used safely and successfully in private medical practices as well as in academic centers for periods exceeding those recommended in the medication product literature.
I understand that there is no guarantee that this program will work for me. I understand that I must follow the program as directed in order to achieve weight loss. By consenting to treatment, I agree to pay, in full. I understand that these charges may not be covered by my insurance and Invisared does not provide or fill out claim forms for insurance purposes. I also understand that no refunds are given out at the end of treatment if I do not see or am not satisfied with the result in the end.
I understand that much of the success of the program will also depend on my efforts and that there are no guarantees or assurances made to me that the program will be successful. I also understand that I may require drastic changes in eating habits and permanent changes in behavior to be treated successfully.
I understand that if I develop side effects from the treatment I sign up for, I will discontinue taking the treatments and notify the Arctic Medical Center staff immediately and in the event the problem is severe, I will go to the nearest Emergency room for immediate care.
By signing below, I certify that I have read and fully understand this consent form and understand the risks and benefits associated with my treatment for weight loss.