Patient name date.
Co2 laser consent form.
Co2 laser skin resurfacing consent for treatment.
Steven c spencer michelle osborne spencer pa amanda smith pa c.
The nature of the fraxel restore dual procedure has been explained to me.
Welcome to omic s consent form library a collection of loss prevention and patient education templates for ophthalmic practices sample letters and office forms are included under the patient or practice categories.
Please read this document carefully.
Before signing this document please ask your physician about any aspect of.
This form is intended as a sample form.
Matrix fractional co2 laser client informed consent.
Safety glasses are worn to protect the eyes from any unforeseen effects.
Do not sign this form without reading and understanding its contents.
I understand there is a possibility of short term effects such as.
Some individuals have a tendency to form raised or thickened scars and this may be unpredictable.
I declare that i understand the following information the goal of co 2 laser skin resurfacing surgery is to reduce or partially eliminate facial wrinkles or reduce scarring from skin conditions such as acne.
For translated forms please visit the consent forms in spanish page.
Fraxel dual is a non ablative fractionated laser.
Place letterhead here and remove note.
Fractional co2 laser uses beamlets of energy light to bore tiny holes in the skin which works to.
Informed consent and release form cortex fractional co 2 laser treatment as a patient it is important for you to understand the expected results and risks of fractional co 2 skin resurfacing with the cortex co 2 laser system.
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Give the patient a copy and send this form to the hospital or surgery center as verification that you have obtained informed consent.
The water within the skin is rapidly heated causing heating of the deep dermis which stimulates to form new collagenand elastinhelping to increase skin turgor and thickness tightness and tone.
Laser energy is not ionizing radiation i e.
These glasses are specific to the type of laser.
Use of a laser for dental treatment hard and or soft tissue and root canal is a very safe and predictable form of treatment.
This consent form is freely and voluntarily executed and shall be binding upon my spouse relatives legal representatives heirs administrators successors and assigns.
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Fractional co2 laser consent form dr.
It is photo thermal produces heat.
Fraxel treatment consent initial that you have read and understand this page.
It contains the information omic recommends you as the surgeon personally discuss with the.
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I understand that the fractional co2 laser is a laser device designed for ablative skin resurfacing and that clinical results may vary in different skin types.
