PHOTOTHERAPY INFORMATION & CONSENT

What is phototherapy?

Phototherapy refers to the delivery of a very narrow spectrum of ultraviolet violet light for the treatment of skin conditions.

Phototherapy works by decreasing the inflammation in your skin hence helping conditions such as psoriasis, eczema, itchy skin, vitiligo and many other skin conditions.

What do treatments entail?

Treatment usually occurs three times weekly but may be reduced for maintenance if required.

You do not need to make an appointment for treatments but rather walk-in at your convenience during clinic hours.

All treatments and follow-up consultations during the course of phototherapy are bulk billed.

You will need to get down to your underwear (do not take underwear off unless instructed otherwise), put on your goggles and enter the UV booth for treatment.

Treatment takes a few seconds and increases with every session. Treatment times do not often exceed 2-3 minutes.

TREATMENTS MUST BE EVERY 2ND DAY (CANNOT HAVE 2 CONSECUTIVE DAYS OF TREATMENT)

Will you be receiving phototherapy on the Whole Body machine or Hands/Feet Machine? *

Whole Body Instructions

Present at reception & sign in
Enter UV room and undress down to underwear (always wear the same shape underwear, to avoid being burnt in previously unexposed areas
Enter UV Booth
Put on goggles
Start in a neutral position with your hands beside you
Press start (lights will turn on and some heat is generated)
Cover face with pillow slip
Once treatment is finished, exit booth, re dress

Hands/Feet Instructions

Present at reception & sign in
Enter UV room
Close door behind you
Sit on chair in front of machine
Put on goggles
Place hands and/or feet in position
Press start
Once treatment is finished, exit room

DO NOT EXPOSE YOURSELF TO ANY SUN (Additional UV) DURING THE COURSE OF YOUR TREATMENTS AS THIS IS LIKELY TO CAUSE A BURN.

IN THE UNLIKELY SCENARIO THAT YOUR CONDITION DOES NOT IMPROVE OR IF YOU FEEL BURNT AFTER TREATMENT, YOU MUST NOTIFY RECEPTION IMMEDIATELY.

What do the treatments cost?
There is no cost to patients for treatments. You will need to purchase special UV goggles and bring a face cover e.g. pillow case, for all your treatments.

Goggles cost $15, once off, unless you forget to bring them for a treatment (in which case you can abort treatment or pay for a new set of goggles.

Review appointments are charged at a reduced rate during the course of therapy.

This will change back to normal review costs if you discontinue phototherapy.

Review appointments with the doctor usually occur every 12-24 weeks.

What NOT to do

Do not use the poles in the booth to pull yourself into the booth

Do not hang any clothing items on the top of the machine

Do not expose yourself to the sun between treatments

Who is completing this form? *

I am the patientI am a parent of the patientI am a guardian of the patient with power of medical attorney

Patient details

Parent/Guardian details

Risks:
As with any medical treatment, there are risks associated with phototherapy, although these are considered small.

Risks with short term treatment - burning, tanning.
Risks with long term treatment (years of continuous treatment) - may increase skin ageing & a possible increased risk of skin cancer development, although studies have demonstrated that there is low to no increased risk.

Declaration

I have read and understood this document and agree to adhere to the instructions. *

I understand that I must not expose myself to any sun during the course of this treatment
*

I understand that I must bring and wear goggles for every treatment (if the doctor has requested me to do so) *

I understand that I must notify the reception staff if I feel burnt after a treatment *

I understand and accept the risks of phototherapy treatment *

I understand that the last patient accepted is 15 minutes before clinic closing time. *

Full name of parent/guardian completing this form *

Signature of guardian/parent *

Clear

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Signature of patient *

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Today's date *

I have completed this form accurately and request that the procedure be carried out. *