Forms for use in cosmetic practice centers, centers for cosmetic surgery, plastic surgeons, healthcare, medical offices.
This notice describes to your clients and patients how medical information about them may be used and disclosed and how the patient can get access to this information.
The Health Information Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by a physician, whether electronically, on paper, or orally, are kept properly confidential. This Act gives the patient, significant new rights to understand and control how their health information is used. HIPAA provides penalties for covered entities that misuse personal health information. This information provided to client or patient is required by HIPAA.
A 2 page, Botox®, 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. Form may be modified or edited to meet your own practice needs and or other types of fillers and treatments.
This form is used used to obtain new client or patient, allergy and medication information. It has room for patient's personal information, allergies, medicines, vitamins and other supplements and for any insulin taken and dosage, keep in mind that form fields can be edited using Microsoft Word or other 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.
An Authorization for Disclosure of Health Information is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.
The form's purpose is to obtain patients signature to be able to use or disclose health information.
English and Spanish bundled together.
A list of frequently asked questions about Botox and Botox injections, patient handout / leaflet. Easily editable using word processor.
This form is find out what procedure(s) your client is interested in, it contains a multitude of cosmetic practice therapies and procedures. Easy to respond check boxes so client can just check mark the procedures of interest. If is followed by a few more questions concerning the personal opinions the client may have about the procedure and if they had previous cosmetic surgery. Get informed on what your customers wish for.
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 release form is used to obtain client authorization to take before and after photographs for documentation purposes. It also grants the physician, if agreed by the client, permission to use such photographs in other types of publications.
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.
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.
This is a Botox Fee Schedule (or for any other type of dermal filler or any type of procedures where you wish to have a price list), includes procedures, prices, payment schedule and signature line for client. May also be used as a fee schedule form for any other type of surgical procedures, easily edit and change form fields to best meet your needs.
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.
Proper, specific, and reproducible labeling of anatomic locations of dermatologic lesions or therapy is important to record as part of a patient's medical history. These drawings can serve as a list of locations treated (e.g. with Botox, etc.) proving very useful on patient's next visit.