Cellebrate Light Intake Form

Please fill out the following form.

Consent for PhotoBioModulation Treatment. PBM Therapy is non-invasive and will not harm you. This treatment is backed by science, is relaxing and most experience great results!

Do you have any of the following conditions?

If you answered YES to any of the above questions, then you are NOT a candidate for light therapy.

If you answered YES to any of the above questions, then you MAY NOT be a candidate for light therapy.

Possible Side Effects

If, after your treatment, you have any problems or concerns, such as uncomfortable heat from the RX System or prolonged redness of the skin, swelling, itching or severe headaches during or after the treatment, please notify me. These are all indications of sensitivity to light, in which case you would discontinue the treatment. These side effects rarely occur and usually subside within 24 hours of discontinuing the treatment.

Pre/Post Treatment Instructions

For a maximum effective treatment, it is important that the treated area be cleaned to remove all moisturizers, lotions, cream and makeup prior to starting any treatment session. Metals, and jewellery should be removed from the area to be treated. Drink water after your treatment.

CONSENT. I agree to the following

I understand the treatment may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks. I am choosing this non-invasive treatment option.

I have carefully read and understand this agreement and fully understand its contents. I release CELLebrate Light, and its operators from any liability associated with this treatment. I certify that I am a competent adult of at least 18 years of age and sign this at my own free will.