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MLS Laser Therapy Form

Patient Registration for MLS Laser Therapy

Birthday
Pain Level:
No pain
A little pain
Moderate pain
A lot of pain
Please check any of the following that apply to you:

Laser Therapy is a non-surgical application of laser light. Unlike most other forms of therapy, laser therapy is classified "actinotherapy" in that it results in a chemical and metabolic change of the involved tissues. As a result, laser therapy can relieve pain, decrease inflammation, accelerate the healing of tissue, increase blood flow and decrease tissue swelling.

Like all forms of medical treatment, there are associated risks as well as benefits. Exposure to the eyes during the procedure may result in damage of the retina. Under certain situations a superficial burn of the skin could occur. This is based upon skin pigmentation, skin discolorations (i.e. tattoos), or the use of topical creams, lotions or analgesic balms.

To prevent adverse reactions to laser therapy, all patients must adhere to the following guidelines:

  • Wear approved safety goggles during all laser treatment session;

  • Avoid the use of any topical creams, lotions or analgesic balms before or immediately after treatment;

  • Inform the technician of any skin conditions including skin sensitivity to light;

  • Remove jewelry or any shiny objects (watches, bracelets, chains, etc.) at or around the treatment area

  • Clean the area of treatment thoroughly prior to your scheduled appointment.


Insurance Coverage

MLS Laser Therapy is cleared for clinical use by the FDS. Insurance reimbursement is very limited at best; therefore, we do not participate with any insurance plans at this time. While laser therapy is not yet covered by traditional insurance, it is affordable to most patients.

By signing below, I acknowledge that I wish to proceed with laser therapy, which my provider has deemed to be medically advantageous in the care and treatment of my condition.

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