LED Light Therapy Consent Form
LED light therapy is the process in which certain colors of light are used to trigger naturally occurring physiological processes in the body, including cellular healing and nitric oxide release. Clinical studies show nitric oxide can help increase and support basic functions in nearly every part of the body including, but not limited to, increased circulation, stimulated collagen production, increased lymphatic system activity, and decreased nervous excitability.  

Possible Benefits of LED Light Therapy:
Reduce the appearance of fine lines and wrinkles by stimulating collagen and elastin production. Reduce the appearance of scars and other skin ailments, such as rosacea by deeply penetrating the skin and promoting the growth of skin cells.
Treat acne by fighting off and killing the bacteria under your skin .

Possible Risks of LED Light Therapy:
Overall, the American Academy of Dermatology deems this procedure safe.
Side effects from LED light therapy are rare and were not noted during clinical trials, may include: redness, rash, pain, tenderness, hives, increased inflammation
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NAME *
PHONE NUMBER *
DATE OF BIRTH *
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STREET ADDRESS, CITY, STATE, ZIP CODE *
By signing this document, I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previously written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/ or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release After Glow Aesthetics from liability and assume full responsibility thereof. The team at After Glow Aesthetics asks that you, please be aware that individual results for any treatment offered may vary. Results are not guaranteed. *
FULL NAME, USED AS SIGNATURE *
TODAY'S DATE *
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TIME *
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IF UNDER THE AGE OF 18, PARENT/GUARDIAN NAME, USED AS SIGNATURE *
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