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Vibradermabrasion Consent Form Mobile App

This consent form for vibradermabrasion, microdermabrasion, jetpeel and chemical peels has been turned into a mobile app. Information covered includes procedures and risks. Please read carefully.

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

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Take a peek inside the Vibradermabrasion Consent Form Mobile App

Included Features

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Included Fields

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

  • Ico statictext

    My signature below constitutes acknowledgement that:

  • Ico textbox

    I (patient name)

  • Ico textbox

    consent to and authorize members of (clinic name)

  • Ico statictext

    to perform one of the following procedures and related services on me.

  • Ico checkbox

    Vibradermabrasion

  • Ico checkbox

    Microdermabrasion

  • Ico checkbox

    Jet Peel

  • Ico checkbox

    Acid Peel

  • Ico checkbox

    Chemical Peel

  • Ico textbox

    Procedure elected is:

  • Ico textbox

    Body Area:

  • Ico textbox

    Those procedures involve the use of a different modalities to remove the top layers of the skin.

  • Ico textbox

    regarding treatment have been answered to my satisfaction.

  • Ico textbox

    and unknown causes and I freely assume these risks.

  • Ico textbox

    provided in this form.

  • Ico textbox

    I agree to adhere to all safety precautions and regulations during the skin treatment.

  • Ico textbox

    hours, use gentle cleanser only, acid washer (if desired) may be resumed 48 hours after treatment.

  • Ico signature

    Patient Signature:

  • Ico date

    Date:

  • Ico signature

    Parent/Legal Guardian:

  • Ico date

    Date:

  • ...and More!

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