Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
Medical Practice Surgery Cancellation Policy, provides information regarding the physician's surgery scheduling and rescheduling policy. It covers areas for scheduling an in-office procedure, scheduling surgery, rescheduling surgery can cancelling surgery, plus fees associated. Acceptance date and signature lines at bottom of form.
A correspondence form to assist in communication and the sharing of information between patient and doctor is important piece. Each phone call, letter, or email is a piece of your patient's story. Sometimes, questions or disputes may arise, and documentation is independent evidence that can clarify details, and help avoid future confusion and misunderstandings.
You may print just a few, as needed, or take the artwork to your local print shop for quantity printing and drilling of holes on top of page.
The form's purpose is to obtain patients signature acknowledging that patient received the HIPAA Privacy Practices Notice.
Did You Know? Under the HIPAA Privacy Rule, the local health department is required to disseminate its Notice of Privacy Practices to all patients upon the first delivery of service after April 14, 2003, and to make a good faith effort to obtain the patient's acknowledgment that he or she has received the Notice.
The form is intended to clarity, to client/patient of their financial responsibility with medical services and procedures.
A new patient intake form to help expedite patient's visit and learn about your patients history and reason for visit, with areas to learn more about your patient's other interest in cosmetic procedures. Obtain patient's home and work address, contact & emergency numbers, services requested, areas of cosmetic interest and past cosmetic procedures history, referral, patient signature line, and more. May be used as is, or easily personalized using compatible word processor.
With its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of new form typesetting and offset printing fees. Print as many as you need and edit them as your office needs change in time.
This release form is used to obtain client photography and interview permission and includes rules by which patient/client must agree to abide in exchange of value received to client/doctor. Protect yourself if you will be taking photographs and/or will be using any other patient material for any type of purpose, be sure to have your client's permission in writing.
Botox Therapy Consent Form. Patient authorizes physician to perform Botox injections and is informed of all that is related to the procedures such as the proposed treatment, anticipated benefits, risks and complications associated with treatment, Botox limitations and alternatives, costs/fees, follow ups, photographs, etc. Consent signature is at bottom and patient consents that all above questions have been answered and accepts the risks and complications of the procedure.
No need to design your form from scratch, with its contemporary design and host of features, it is sure to enhance any cosmetic practice or existing medical or doctor's office wanting to do away with their old patient intake forms and replace them with new, updated, contemporary forms without going through the expense of starting from a new form or form typesetting and offset printing fees. Print as many as you need and edit them as often as needed.
Botox® Treatment Consent to Treat a Minor Form. The parent or guardian of a minor, authorizes physician to perform cosmetic treatment and is disclosed information concerning Botox, how it injected, side effects, what to expect, patient also acknowledges the limitations of Botox treatments and possible side effects and dangers. Patient consent date and signature signature lines at bottom of form. Physician should examine form to see if it may benefit his/her practice to help keep patients legally informed and physician from legal problems.
This Planning for Cosmetic Surgery brochure is a great planning toolkit and a helpful resource to answer your patient's general questions and address basic information that may be relevant to their plastic surgery experience. Patient safety should be your highest priority and informing your patients will be your biggest asset. Teaching your patients about their options will help them be educated patients, better prepared for physician consultations and ready to decide on which procedure is right for them.
This is a great brochure and editable using Microsoft Word. Easy to personalize, once completed, print, in your office, as many as needed, or deliver camera-ready artwork to your local speedy printer or print shop, for quantity brochure printing.
Pre treatment instructions for Restylane® treatment, leaflet with instructions for patients who will be receiving Botox injections. What to expect, what to do prior to treatment, what to do 24 to 48 hours before treatment, additional recommendations and notice of who should not be treated with Restylane. To avoid legal issues be sure you patient is well informed, before and post treatment.
A superbill is a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement. It is generally customized for a provider office and contains patient information, the most common CPT (procedure) and ICD (diagnostic) codes used by that office, and a section for items such as follow-up appointments, copays, and the provider’s signature.
The super bill is bundled with Microsoft Word forms and a fillable PDF form for use with free Adobe Reader. Both forms can be personalized with your practice name, address, contact numbers, etc. The Word form is fully editable, the PDF form you can only edit your practice business name, address, etc.
Provide your clients and customer with a welcoming letter showing that you respect their rights to dignity and pride with the Patient's Rights notice / handout.
This document will explain your patient rights and responsibilities. It is part of your patient's registration and is an important part their health care. Our commitment to your patients should include and inform them of their rights and responsibilities. This notice complies with applicable Federal civil rights laws and affirm that the clinic will deliver high-quality health care to every patient