LED scalp therapy consent form: light-sensitizing medicines, eye protection and a series
LED is easy to deliver and hard to set expectations for. Your consent has two jobs: catch the medicines and conditions that make skin react to light, and be honest that a series is a routine, not a guaranteed result.
This exact form is built into SlickChart: send it to your client's phone to sign before the visit, and the LED aftercare goes home with them.
Say what the light is, in one box
My form opens with an "about this service" box. It is low-level red light, about 630 to 660 nm, or blue light, about 415 nm, on a clean scalp, per the device you use. A session takes about 10 to 20 minutes of relaxing, painless light, with eye protection worn throughout.
The same box sets the commitment: light works best as a series of 8 to 12 sessions, once or twice a week, per your policy. Then they check today's service: red light, blue light, an add-on to the ritual, or a series, with a short field for which session of how many.
Be honest about results
This is the line I would never leave out, and it appears more than once on the form:
I understand this is a cosmetic service. Results vary and hair regrowth is not promised.
The risk list says it too. My aftercare repeats it at the series review, and adds that ongoing hair loss needs a dermatologist. LED here is a cosmetic service, and diagnosing or treating hair loss is a dermatologist's job.
Possible effects and risks
The list is short: gentle warmth during the session, eye strain or glare without eye protection, redness if the client is on a light-sensitizing medicine, mild pinkness or tightness for a few hours, a brief headache in light-sensitive people, and dryness on a dry or sensitive scalp.
A health check built around light
Fifteen items, and most are about light sensitivity: light-triggered epilepsy, some types of antibiotics, other light-sensitizing medicine, a skin cancer history, open sores or a scalp infection, light-triggered migraine, retinoids taken by mouth or used on the skin, lupus or light sensitivity, a new or changing scalp spot, a psoriasis or dermatitis flare, pregnancy, St John's wort, an eye condition or recent eye surgery, a sunburned scalp, and using a home light device.
My pre-visit guide asks a week ahead for any light-sensitizing medicines. A check starts a conversation, and what a medical condition means is for their doctor to say.
The promises on the signature page
- They have shared their full health history, including every medicine and supplement.
- They will keep eye protection on for the whole session and will not look directly at the light.
- They will speak up right away about heat, discomfort, a headache, or if the light bothers them.
- If a scalp spot looks unusual, they will be asked to see a dermatologist, and no diagnosis is given in the studio.
- They will tell you before each session if they start a new medicine, become pregnant or their health changes.
- Before and after scalp photos for their private record are OK, with social media use only with their separate OK.
The "before each session" promise matters for a series: a new antibiotic in week three changes things.
Aftercare across a series
My LED guide starts with reassurance: light therapy is gentle and there is no downtime. Then it follows the series, not the day:
- First hours: gentle warmth or slight pinkness for an hour or two, and most people notice nothing. A hat or scalp sunscreen outdoors. No long sun exposure on the scalp, tanning beds or very hot showers.
- Between sessions: no visible change yet, because light works slowly. Gentle shampoo, lukewarm water, a clean and product-light scalp. No skipped sessions, and no new medicines you have not been told about.
- Mid-series, sessions 4 to 8: some notice a healthier-feeling scalp, others little change. Compare photos together.
- Series end: results vary and regrowth is not promised. Review photos together and plan upkeep sessions.
The call-me list covers burning, blisters or a rash, eye pain or vision changes after a session, redness that lasts beyond a day or spreads, and a headache or migraine that will not settle. Eye pain or vision changes means seeing a doctor the same day.
Questions to decide for your own practice
- Will you sell LED only as a series, or single sessions as a ritual add-on too?
- How will you track session numbers and photos, so the series review has something to compare? My head spa intake form post covers the analysis plan.
- LED is the alternative my high frequency scalp consent offers to clients with a pacemaker or implant. Do you check the LED list for them too?
- Device rules vary by state, so check your state board's rules on licensing and devices. This post is not legal or medical advice.
The full collection is on my head spa forms page.
Use this form with your clients
SlickChart has this exact LED light scalp consent and aftercare built in for subscribers. The form goes to the client's phone to sign before the visit, or they sign on your device in the room, and any contraindication they check is flagged for you. The aftercare lands in the client's own app, styled with your logo, and it all works alongside the Square account you already have. If that would save you paperwork, try SlickChart.
Prefer paper? The printable head spa set, with this LED consent, the protocol and the aftercare, is in my Etsy shop, ready to print or edit in free Canva.