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Spider Vein Consent for Treatment Form Mobile App

This consent for treatment of melasma/age spots, deep veins, spider veins, and tattoo removals has been turned into a mobile app and used by healthcare professionals to inform patients of potential risks. Information covered includes scarring, bleeding, infection, and other risks of laser surgery. Additionally, users can customize this consent for treatment form in order to fit their own forms. Please read carefully.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Spider Vein Consent for Treatment Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico textbox

    Patient name

  • Ico textbox

    I authorize Body Focus Laser & Longevity Center to perform the procedure of:

  • Ico statictext

    This pulse system may dramatically reduce darkly pigmented sunspots and spider veins.

  • Ico textbox

    The skin treated will be red swollen with fine, thin scabs forming.

  • Ico statictext

    We are unable to treat clients that are on ACCUTANE and PHOTOSENSITIZING medications.

  • Ico statictext

    The following problems may occur with treatment:

  • Ico textbox

    the skin.

  • Ico textbox

    especially with a darker complexion.

  • Ico textbox

    and viral infection can occur.

  • Ico textbox

    treatment procedures.

  • Ico textbox

    Skin tissue pathology: Energy directed at skin lesions may potentially vaporize the lesion.

  • Ico textbox

    topical preparations, have been reported.

  • Ico textbox

    Wear sunscreen of SPF 25 or higher before and after treatment to protect the skin.

  • Ico textbox

    I understand I may need multiple treatments for the desired outcome.

  • Ico textbox

    I understand that exposure of my eyes to light could harm my vision.

  • Ico textbox

    hyper-pigmentation and hypo-pigmentation.

  • Ico textbox

    rescheduled.

  • Ico statictext

    My question regarding the procedure has been answered satisfactorily.

  • Ico signature

    Patient/Guardian Signature:

  • Ico date

    Date

  • Ico signature

    Laser Technician Signature:

  • Ico date

    Date

  • ...and More!

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