Patient Forms

• COVID-19 Screening
• CONSENT – COVID-19 Informed Consent Waiver

• PATIENT INTAKE FORM – Surgical
  Breast Consultation – Patient History Form
• Consult and Surgery Bookings For Out of Town Patients (Breast)
• Consult and Surgery Bookings For Out of Town Patients (Face)

Pre-operative:

• Pre Surgical History Form
• Surgery Preparation Checklist – COVID MODIFIED
• SURGICAL PATIENTS – What To Expect – (for Dr. Ken Smith’s patients)
• SURGICAL PATIENTS – What To Expect – (for patients of visiting surgeons)
• INFO SHEET – Booking Hotel Stay

Post-operative:

Scar Management
JP Drain Management at Home

Medical aesthetics – intake forms:

• PATIENT INTAKE FORM – Non-Surgical
• AESTHETIC QUESTIONNAIRE – Feminine
• AESTHETIC QUESTIONNAIRE – Masculine
• Virtual Skincare Consultation Questionnaire

Medical aesthetic procedure – info sheets:

• Dermal Filler Checklist
• Laser Genesis Information Sheet
• Laser Genesis Information Sheet
• Laser Genesis Post-treatment Instructions Sheet
• Pearl Information Sheet
• Pearl Post-treatment Instructions Sheet
• Pearl Fractional Information Sheet
• Leg Veins & Vascular Therapy Information Sheet
• Leg Veins & Vascular Therapy Post-treatment Instructions Sheet
• INFO SHEET – IPL Photorejuvenation
• eTwo™ Information Sheet
• Photodynamic Therapy (PDT) Information Sheet