Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
A patient's guide listing frequently asked questions about Restylane® and Restylane injections, patient handout / leaflet. Easily editable using word processor.
Put your clients at ease and provide them with Restylane injection information.
This New Client Information form can be used to obtain patient information as an intake or registration form. Its contemporary and clean design makes it easy for clients/patients to read and answer the questions. May be used as is, or easily editable using Microsoft Word to assist you in asking only the questions that you wish to obtain from your patients.
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.
General botox, facial injections consent form. Patient authorizes physician to perform Botox injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back. Form may be modified or edited to meet your own practice needs.
This form is used used to obtain new patient medical history. Form is divided into 4 sections. Patient information, past medical history, medications, and the last section is reserved for women only. May be used as is, or easily personalized to your individual needs, using compatible word processor.
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.
This fact sheet should accompany any concentrator rented to a patient. It will teach patient safe use of an oxygen concentrator. Protect yourself, be sure you have outlined safety precautions to the patient and leave a safety guidelines sheet with the concentrator.
This release form is used to obtain client authorization to take photographs for use as an aid in patient's treatment. Protect yourself if you will be taking patient photographs, be sure to obtain your client's permission in writing. Form uses industry standard, legal wording section and may be fully edited or modified using Microsoft Word or other word processors.
This form is used provided to client by physician so he can obtain a comprehensive breast history prior to considering breast surgery.
Includes both, sections for written responses and multiple choice using check boxes. Fully edit the questions to your particular practice needs.
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
This form recognises that there are patients, members of the community who cannot speak English, and others that have other communication needs. This translation statement is intended to ensure that measures are in place across the office to support communication with everyone whose first language is not spoken english, does not communicate by the spoken work or has any form of communication difficulty.
The form acknowledges that the health care or interpreter has explained the procedure or course of treatment to the patient to the best of his/her ability and acknowledges that he/she believes the patient has understood. Signature and date lines for patient and interpreter.
Protect your rights, be sure non English speaking patients have had all procedures explained, what procedure is likely to involve, including risks, alternative treatments, including no treatment and any particular concerns to patient and that he/she fully understood, avoid legal issues along the way.
Did You Know? Responsibility for arranging translation or interpreting services lies with the organisation and not the service user.
Botox Treatment Consent Form. Patient 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.
A more complete, 3 page, Restylane®, facial injections consent form. Patient authorizes physician to perform Restylane injections into muscles covering patient's forehead, face, chewing muscles, scalp, neck, or upper back, it also informs of risks and alternative treatments.
It is divided into several sections, Instructions; Introduction, what Restylane is, what it has been approved for, and general information about the effects; Alternate Treatments; Risks of Restylane; Normal Occurrences During Tissue Filler Injections, Including Restylane; Complications and Health Insurance.
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.