Co2 Laser Consent Form

Do not sign this form without reading and understanding its contents.

Co2 laser consent form.

Matrix fractional co2 laser client informed consent. For translated forms please visit the consent forms in spanish page. This form is intended as a sample form. I understand there is a possibility of short term effects such as.

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. Save this form to your computer by using the download button. Co2 laser skin resurfacing consent for treatment.

Patient name date. 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. Before signing this document please ask your physician about any aspect of. It contains the information omic recommends you as the surgeon personally discuss with the.

Give the patient a copy and send this form to the hospital or surgery center as verification that you have obtained informed consent. Safety glasses are worn to protect the eyes from any unforeseen effects. Laser energy is not ionizing radiation i e. A co2 laser uses a wavelength of 10 600 nm which makes water molecules the effective target of the laser energy.

Steven c spencer michelle osborne spencer pa amanda smith pa c. 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. It is photo thermal produces heat.

Place letterhead here and remove note. Use of a laser for dental treatment hard and or soft tissue and root canal is a very safe and predictable form of treatment. These glasses are specific to the type of laser. Please read this document carefully.

Co2 laser skin resurfacing consent form. Change font size for large print. This consent form is freely and voluntarily executed and shall be binding upon my spouse relatives legal representatives heirs administrators successors and assigns. Fractional co2 laser consent form dr.

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. A preview is displayed below. Fraxel dual is a non ablative fractionated laser.