Eileen C. Comia, M.D.
35 Jolley Drive Suite 102
Bloomfield CT 06002
Tel (860)242-2200
Fax (860)242-2212
XLR8 Cold Laser Therapy is an FDA-cleared, non-invasive, fast and effective modality that has been
proven in clinical trials to reduce pain, reduces edema, and promotes healing. It is scientifically-proven to
relieve pain up to 70%. It works by using low intensity photonic energy as a treatment modality. Photonic
stimuli excite the body’s cells infusing them with energy, with the three primary reactions being, reduction
of inflammation, cell regeneration, and increased blood flow.
The potential uses of the XLR8 are almost limitless; the manufacturer Erchonia has received market
clearance for pain. It continues to conduct clinical trials on other applications. There are other off-label
There are no code-regulated contraindications in the use of Low-Level Laser therapy. Although no known
detrimental risks exist, potential unknown risks may exist. There are no known and/or published adverse
effects. Since there are no long-term evaluations on certain conditions, Erchonia does not recommend its
use on pregnant women or persons with a pacemaker. Other contraindications include a defibrillator,
electrical stimulator, and active cancer. Should you have any of these conditions, please inform the
physician or medical staff.
Alternatives treatments are available which may have their own risks and benefits.
I have reviewed this XLR8 Cold Laser consent form. My consent and authorization for this procedure are
strictly voluntary. The treatment results vary and there is no guarantee that the desired results will be
By signing below, I grant authority to Dr. Eileen Comia and/or her staff to perform the described treatment
or administer any related treatment as deemed necessary or advisable for my medical condition. I certify
that I understand the contents of this informed consent form. I have had enough time to consider the
information and feel I am sufficiently advised to consent to this procedure.
_____________________________________ Date of Birth: ___ / ___ / _____
Printed Name
_____________________________________ _________________
Signature of Patient Date