Co2 Laser Consent Form

This form is intended as a sample form.

Co2 laser consent form. Fractional co2 laser consent form dr. Before signing this document please ask your physician about any aspect of. Safety glasses are worn to protect the eyes from any unforeseen effects. Co2 laser skin resurfacing consent for treatment.

I understand there is a possibility of short term effects such as. Co2 laser skin resurfacing consent form. For translated forms please visit the consent forms in spanish page. 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.

Place letterhead here and remove note. Laser energy is not ionizing radiation i e. Fraxel treatment consent initial that you have read and understand this page. Patient name date.

These glasses are specific to the type of laser. The nature of the fraxel restore dual procedure has been explained to me. Change font size for large print. 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.

Some individuals have a tendency to form raised or thickened scars and this may be unpredictable. Do not sign this form without reading and understanding its contents. Medications are available to treat such complications but in rare cases. A preview is displayed below.

This consent form is freely and voluntarily executed and shall be binding upon my spouse relatives legal representatives heirs administrators successors and assigns. Fraxel dual is a non ablative fractionated laser. It is photo thermal produces heat. Steven c spencer michelle osborne spencer pa amanda smith pa c.

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. 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. Save this form to your computer by using the download button. Matrix fractional co2 laser client informed consent.

Please read this document carefully. A co2 laser uses a wavelength of 10 600 nm which makes water molecules the effective target of the laser energy. 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.