New Patient Consultation (Free Evaluation & 15 Minutes Session)

Cancellation Policy

I understand that a non-invasive, class IV laser is being used for my treatment. Although laser therapy is safe and effective in the majority of cases, unexpected adverse events may occur. Side effects may result from the use of the laser & the expected response of the treated area may not be achieved. • Short term effects: I understand that there are multiple short term effects that may occur, including reddening, irritated area, and mild burning. These effects typically resolve within several days. I understand that the degree of the side effects varies from person to person, and it may not be possible to predict how I will respond. • Discomfort associated with procedure: I understand that the laser functions by heating up its primary treatment area. This heating sensation is minimized but some level of discomfort may be felt. The level of discomfort depends on the treatment being done, and varies from person to person. The stinging or sensation of heat is typically short. • Need for multiple treatments: I understand that some conditions being treated by the laser may require multiple treatments to obtain the desired results. Everyone responds in different ways and different rates to the treatment. • Tattoos: If there are any tattoos or permanent makeup in the area, there is a possibility the tattoo will heat at a faster rate. • I agree to wear proper eyewear. Eye injury due to use of the laser is a risk to the patient and to the clinician; however, the risks are almost completely eliminated with the use of proper eyewear. • I understand that this procedure is elective & there are other options for treatment including no treatment. • I am responsible for the complete cost of the service. Payment is due at the time of the treatment unless other arrangements have been made in advance. I also understand that once I have started my treatment program, there are no refunds. The Phoenix Thera-Lase certified technician has explained the nature and purpose of the laser treatment, including any risks and possible complications, and has discussed the contents of this form with me. I have read and understand this consent form & I agree to its terms and authorize treatment. I do hereby waive, release, absolve, indemnify and agree to hold harmless Phoenix Thera-Lase Systems, LLC for my individual treatment results. I further understand that results CANNOT be guaranteed.

Contact Details

• 5725 Bagby Avenue, Waco, TX, USA

  +12544337790

  info@republictheralase.com