Patient Forms
Documents and Forms
COVID-19 Screening & CONSENT:
Surgical Consultations:
- 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
Consent Forms:
- Clinic 805 – COVID-19 Informed Consent Waiver
- CONSENT – Communications
- Release of Patient Information Form