(all of the appropriate forms needs to be completed prior to visit and brought to the center or this could delay your appointment)
DEMOGRAPHICS
PG1: PATIENT INFORMATION
PG2: SKIN EVALUATION FORM
PG3: HISTORY AND PHYSICAL
PG4: FITZPATRICK SKIN TYPE QUESTIONNAIRE
PG5: DISCLOSURE INFORMATION
PG6: PATIENT ACKNOWLEDGEMENT OF DISCLOSURE
PG7: AUTHORIZATION TO RELEASE MEDICAL PHOTOS/SLIDES OR VIDEO FOOTAGE
PG8: PATIENT WISH LIST WISH LIST – EMAILED ATTACHMENT
ALL QUESTION’S YOU MAY HAVE, WILL BE ANSWERED THE DAY OF YOUR APPOINTMENT
CONSENTS
#1 MICRODERMABRASION/CHEMICAL PEELS
#2 LASER HAIR REMOVAL
#3 IPL CONSENT
#4 IPL DISCLAIMER AND CONSULT RECAP
#5 VI PEEL CONSENT FORM
PRE/POST DIRECTIONS
CHEMICAL PEEL / MICRODERMABRASION
SPRAY TAN
DOT FRACTIONAL
LASH AND BROW TINTING
HYDRA-FACIAL
LASER VEIN REMOVAL
LASER HAIR REMOVAL
