LED light therapy consent form: eyes, medicines and a series plan
LED is the treatment where the client lies back, closes their eyes and usually feels nothing at all. Because it feels like nothing, it's easy to skip the paperwork. That's backwards. With LED, the questions that matter aren't about the skin you can see. They're about medicines, eyes and seizures, which a client will never think to mention unless you ask.
This exact form is built into SlickChart, so you can send it to your client's phone to sign before the visit.
Explain what the light is, and isn't
My form says there is no UV in the first sentence, then explains the colors in plain words:
What it is: Low-level light from LEDs, with no UV. Blue light works near the surface and is used for breakouts. Red and invisible near-infrared reach deeper and are used for calming and the look of fine lines.
Note the wording "the look of fine lines". That keeps the promise cosmetic, which is where it belongs.
"What you'll feel" says usually nothing, or gentle warmth, with eye protection the whole time. It also asks the client to speak up if they feel hot, dizzy, get a headache or want to stop.
Sell the series honestly
LED results build slowly. My form says changes are gradual and need a series of 8 to 12 sessions, then maintenance, and that results vary, aren't permanent and aren't guaranteed. Alternatives are listed too: no treatment, homecare products, other facials, or a referral to a physician for medical light treatments or prescription care.
Because LED is usually sold as a package, my form includes a line the client agrees to directly: this covers my LED series, my questions were answered, and services can't be refunded. One signature for the series means your recheck of health changes at each session has to be real.
The risks are uncommon, so say so
My risk section is labeled uncommon, which is honest. It covers temporary redness, warmth, dryness or tightness; eye strain, glare or a headache; a rash or irritation if the client takes a light-sensitizing medicine; and darker patches in some skin tones, or a flare of rosacea.
Each of those connects to a screening question below.
Screening: the section that matters most
My checklist opens by saying a yes doesn't always mean no treatment, and that I follow the device maker's guidance and may adjust, reschedule or ask for the client's physician's OK.
What I screen for:
- Epilepsy, or seizures or migraines set off by light
- Light-sensitizing medicine (for example some antibiotics, isotretinoin, lithium)
- Lupus or another light-sensitive condition
- A retinal or inherited eye condition, or recent eye surgery
- Pregnant or nursing
- Cancer now, or skin cancer in the area
- Botox, filler, peel, laser or a new tattoo in the area in the past 2 weeks
- Rash, wound, cold sore or infection in the area
Clients rarely connect an antibiotic to a facial, so giving examples right in the checkbox helps. The checklist is for screening and referral, not for naming a condition.
Eye protection gets its own agreement
I give eye safety its own line, because it's the one rule the client actively follows during the session:
"I'll keep the eye protection on and my eyes closed, and I won't look into the lights."
The client also confirms they've shared their health history honestly and will tell me about any change, including new medicines, and that LED is a cosmetic service, not medical treatment, which they can stop at any time. Then a guardian name for anyone under 18 and a signature.
Aftercare: short, but still in writing
There's no downtime, so clients assume there's no aftercare. My guide is brief but specific. Right after, a healthy glow or slight pinkness that fades within an hour or so is normal, makeup is fine if the skin isn't red, and they should avoid rubbing the face or eyes and long, direct sun exposure. In the first 24 hours, skin may feel a little dry, and a breakout may surface as blemishes come to a head.
Between sessions, the guide asks them to tell me about any new medicine or supplement, not to pick, and not to skip sessions. After the series, maintenance is about every 2 to 4 weeks, and they shouldn't use a home LED device without asking first, so we don't overdo it.
It also lists when to call: redness or a rash lasting more than a day, blisters or skin that feels sunburned, eye pain, spots, blurry vision or headaches after treatment, or new dark patches. For keeping a series on track, see rebooking for solo estheticians.
Questions to decide for your own practice
- What does your device maker's guidance say, and does your form match it?
- How will you recheck medicines at every session in a series?
- What is your refund policy for an unfinished series, and is it written down?
- Will you pair LED with other facials, such as an acne facial?
Consent requirements and scope of practice vary by state, so check with your state board. This is not legal or medical advice.
Using it digitally
SlickChart has this exact form and aftercare built in for esthetician subscribers. The client signs on their phone before the visit, or on your device in the room, and any checked contraindication is flagged for you. The aftercare goes to the client's own app, styled with your logo, and it works alongside the Square account you already have. If that sounds simpler than a clipboard, try SlickChart.
Prefer paper? The printable LED light therapy set, with the consent form, protocol and aftercare, is in my Etsy shop, ready to print or edit in free Canva.