Co2 Laser Consent Form

Safety glasses are worn to protect the eyes from any unforeseen effects.

Co2 laser consent form.

Laser energy is not ionizing radiation i e. Patient name date. Do not sign this form without reading and understanding its contents. Co2 laser skin resurfacing consent form.

Matrix fractional co2 laser client informed consent. Change font size for large print. Please read this document carefully. 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. Fractional co2 laser consent form dr. These glasses are specific to the type of laser. The nature of the fraxel restore dual procedure has been explained to me.

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. Some individuals have a tendency to form raised or thickened scars and this may be unpredictable. A co2 laser uses a wavelength of 10 600 nm which makes water molecules the effective target of the laser energy. A preview is displayed below.

It is photo thermal produces heat. Place letterhead here and remove note. 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. It contains the information omic recommends you as the surgeon personally discuss with the.

Steven c spencer michelle osborne spencer pa amanda smith pa c. Fraxel dual is a non ablative fractionated laser. Use of a laser for dental treatment hard and or soft tissue and root canal is a very safe and predictable form of treatment. Co2 laser skin resurfacing consent for treatment.

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. Before signing this document please ask your physician about any aspect of. Medications are available to treat such complications but in rare cases. 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.

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 uses beamlets of energy light to bore tiny holes in the skin which works to. Give the patient a copy and send this form to the hospital or surgery center as verification that you have obtained informed consent. I understand there is a possibility of short term effects such as.