Co2 Laser Consent Form

Steven c spencer michelle osborne spencer pa amanda smith pa c.

Co2 laser consent form.

Change font size for large print. 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. A co2 laser uses a wavelength of 10 600 nm which makes water molecules the effective target of the laser energy. Co2 laser skin resurfacing consent form.

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. Place letterhead here and remove note. Save this form to your computer by using the download button. Laser energy is not ionizing radiation i e.

Do not sign this form without reading and understanding its contents. Please read this document carefully. 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. It is photo thermal produces heat.

I understand there is a possibility of short term effects such as. This form is intended as a sample form. Fraxel treatment consent initial that you have read and understand this page. Safety glasses are worn to protect the eyes from any unforeseen effects.

Co2 laser skin resurfacing consent for treatment. Fraxel dual is a non ablative fractionated laser. Patient name date. Before signing this document please ask your physician about any aspect of.

For translated forms please visit the consent forms in spanish page. Fractional co2 laser consent form dr. It contains the information omic recommends you as the surgeon personally discuss with the. Matrix fractional co2 laser client informed consent.

This consent form is freely and voluntarily executed and shall be binding upon my spouse relatives legal representatives heirs administrators successors and assigns. Medications are available to treat such complications but in rare cases. Some individuals have a tendency to form raised or thickened scars and this may be unpredictable. 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.

Fractional co2 laser uses beamlets of energy light to bore tiny holes in the skin which works to. These glasses are specific to the type of laser. Give the patient a copy and send this form to the hospital or surgery center as verification that you have obtained informed consent. The nature of the fraxel restore dual procedure has been explained to me.