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Contraindications (Laser therapy should not be performed)

Do you have a known history of HIV/AIDS?(Required)
Have you ever been diagnosed with leukemia (past or present)?(Required)
Is there any cancerous tissue in or near the treatment area?(Required)
Are you currently experiencing active bleeding or hemorrhage?(Required)
Do you have a pacemaker, and is the treatment area over your thoracic spine?(Required)
Are you currently pregnant, and is the treatment site near the lumbar spine or hip?(Required)

Use with Caution (Laser therapy may be performed with adjustments or further clinical assessment.)

Are you currently taking any anticoagulants (blood thinners)?(Required)
Do you have a hemorrhagic condition or bleeding predisposition?(Required)
Are you taking any photosensitizing medications (that increase light sensitivity)?(Required)
Such as: Tetracyclines (e.g., doxycycline, tetracycline) Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) Sulfonamides (e.g., sulfadiazine, sulfamethoxazole) Retinoids (e.g., isotretinoin, Tretinoin)
Do you have a history of seizures triggered by light exposure?(Required)

Informed Consent for Laser Therapy

PATIENT ACKNOWLEDGMENT

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