Laser therapy is a non-surgical application of laser light. Unlike most other forms of therapy, laser therapy is classified as an “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 (biostimulation), increase blood flow and decrease tissue swelling.
Like all forms of medical treatment, there are associate risks as well as benefits. Exposure to the eyes during the procedure may result in damage to 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.
In order to prevent adverse reactions to laser therapy, all patients must adhere to the following guidelines:
Yes, I acknowledge that I have read the INFORMED CONSENT DISCLAIMER and I wish to proceed with laser therapy administered by Dr. Costello and his staff.
All orthotics, braces & nutritional supplements are non refundable / non returnable because they are either custom made for you or are for your personal medical use only.
We will make every effort to ensure that a device which is prescribed for you fits properly and is comfortable for you to use or wear as prescribed by the doctor for your condition. Please note that on some occasions, adjustments and or modifications are necessary.
Our office will make the necessary modifications to your custom orthotics at no additional charge to you.
Please understand that our office will not dispense custom orthotics, braces or nutritional supplements to any patient unless the check box below is selected by the patient, their legal guardian or a parent. By selecting the checkbox below you agree you have read and understand the ORTHOTICS, BRACES & NUTRITIONAL SUPPLEMENTS POLICY and agree to be bound by its terms.
Thank you for trusting your medical care to Laser Medica. In order to provide the excellent medical treatment which we do to all of our patients, our philosophy requires allowing ample time for each patient’s individualized treatment. To accomplish that, we employ a precise scheduling and appointment system.
We wish everyone to understand our scheduling and appointment policy, which is as follows:
1. Patients who wish to schedule appointments days or weeks in advance of the actual appointment time must leave a credit card on file with the office. That credit card information is kept in a secure location and may only be accessed by Dr. Costello. With your credit card on file, you are welcome to schedule your next appointment or series of appointments at any time.
2. Patients scheduling advanced appointments acknowledge by signing this document that you must either appear for the appointment at the time scheduled, or give Laser Medica no less than 24 hours advance notice of your intent to cancel or reschedule the appointment. Provided you adhere to these rules, you will not be charged for a previously scheduled appointment if you cannot attend. Our pre-scheduling appointment policy is necessary so that patients awaiting treatment who have not been able to schedule an appointment can be fit into the time slot that you cancel.
3. Patients who do not wish to leave a credit card on file may only schedule an appointment by calling for said appointment on the morning of the day that they wish to be treated.
4. You may schedule appointments, at any time during normal business hours /6 days a week. The scheduling numbers are:
Via Phone: 561-882-1430
Via Text Message: 561-329-5597
5. Laser Medica, LLC operates on a precise schedule. If you are late for an appointment, you may not be seen at the appointed time. Your appointment slot will be filled by another patient, and the doctor will see you as soon as possible. However, patients arriving for appointed times will be see at their appointed times and late patients will be required to wait until the doctor is available.
6. I ACKNOWLEDGE THAT SHOULD I FAIL TO ATTEND MY APPOINTMENT WITHOUT PROVIDING THE REQUIRED 24 HOURS NOTICE OF CANCELLATION OR RESCHEDULING, I WILL BE BILLED THE FULL CHARGE FOR THE MISSED APPOINTMENT.
7. I further acknowledge that I may not question or contest a credit card charge for a missed appointment and understand that this form will be provided to my credit card company if I attempt to do so.
I acknowledge that I have read and understand this Medical Appointment Cancellation Policy and agree to be bound by its terms.
Dr. Costello makes every effort possible to help his patients, to treat their conditions successfully and to eliminate their pain. However, it is both legally and ethically improper for any physician to guarantee a successful result to his patients under any circumstances on account of the services he provides.
Therefore, be advised that neither Dr. Costello nor Laser Medica, LLC, guarantee in any way, expressly or by implication, verbally or in writing either the results or a cure for your condition based on the treatment given.
Each patient's condition is unique and each treatment plan is customized for that particular patient. Although the vast majority of our patients achieve the desired results within their initial 10-24 visits, there are some instances where a patient will require additional treatments and others where a patient will require periodic maintenance therapy in order to maintain their results on an ongoing basis.
A message from Dr. Costello
Welcome to my office. I have devoted my life to this practice. I treat patients at Laser Medica 6 days a week. I am committed to helping patients with chronic pain achieve relief when other treatments fail.
Laser Medica is therefore, the most unique practice in the United States.
Please understand, being accepted at Laser Medica is a privilege and not a right!
We therefore, reserve the right to accept patient’s on a case-by-case basis.
Based upon my 30 years of experience and advanced training, I will formulate a medically necessary treat- ment plan that in most cases can provide long term relief for most patients. Laser medicine is not easy, it takes great skill and finesse in order to achieve our mutual goals.
Please understand, your condition did not develop overnight, it will take time to heal!
My team and I take it very personally when patients do not adhere or follow through with the pre- scribed treatment plan as outlined during the evaluation and consultation. This ultimately inhibits you from achieving your desired results. Therefore, Laser Medica reserves the right to terminate patients from our practice who did not follow through with the prescribed treatment plan for their condition.
Dr. Costello is a sole practitioner and all of his Patients’ treatments are administered directly by him in order to achieve the best results possible. Treating these Patients takes up virtually all of the time in the Doctor’s day, leaving him no time to speak with patients on the phone. Please understand, the Doctor’s time constraints do not permit him to return phone calls. However, Dr. Costello is more than willing to speak with patients in the office pursuant to scheduled consultation appointments. We therefore ask our patients to schedule in office consultations with the Doctor. There is never a charge for such a consultation. Thank you for your understanding.
By checking the box below I acknowledge that I will follow the CELL PHONE POLICY.
MLS ROBOTIC Laser: $100 (30 Minutes)$150 (60 Minutes)
Noveon / Nail Fungus:$150 (60 Minutes)
Orthotics: $375 (First Pair)$275 (Second Pair)