Co2 Laser Consent Form

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.

Co2 laser consent form.

I understand there is a possibility of short term effects such as. Co2 laser skin resurfacing consent for treatment. Give the patient a copy and send this form to the hospital or surgery center as verification that you have obtained informed consent. This form is intended as a sample form.

A co2 laser uses a wavelength of 10 600 nm which makes water molecules the effective target of the laser energy. Laser energy is not ionizing radiation i e. These glasses are specific to the type of laser. Some individuals have a tendency to form raised or thickened scars and this may be unpredictable.

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. A preview is displayed below. Save this form to your computer by using the download button.

Medications are available to treat such complications but in rare cases. Change font size for large print. Matrix fractional co2 laser client informed consent. 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.

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. Co2 laser skin resurfacing consent form. 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.

Fraxel dual is a non ablative fractionated laser. This consent form is freely and voluntarily executed and shall be binding upon my spouse relatives legal representatives heirs administrators successors and assigns. The nature of the fraxel restore dual procedure has been explained to me. Use of a laser for dental treatment hard and or soft tissue and root canal is a very safe and predictable form of treatment.

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. Safety glasses are worn to protect the eyes from any unforeseen effects. Fractional co2 laser consent form dr. Steven c spencer michelle osborne spencer pa amanda smith pa c.

It is photo thermal produces heat. Before signing this document please ask your physician about any aspect of. Patient name date. Please read this document carefully.