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Refresh Dermatology Eclipse Micropen Patient Consent free printable template

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4914 Bissonnet Street, Suite 100, Houston, TX 77401 ECLIPSE MICROPEN PATIENT CONSENT FORM Procedure Description: The Eclipse Micropen skin needling system allows for controlled induction of the skins
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How to fill out Refresh Dermatology Eclipse Micropen Patient Consent Form

01
Begin by reading the entire form carefully to understand the procedure and its risks.
02
Fill in your personal details, including your full name, date of birth, and contact information.
03
Provide your medical history, including any allergies or previous skin treatments.
04
Read the section regarding the procedure and explain any doubts you may have with your dermatologist.
05
Sign and date the consent form to indicate your understanding and agreement to proceed.

Who needs Refresh Dermatology Eclipse Micropen Patient Consent Form?

01
Patients who are considering or scheduled for treatment with the Eclipse Micropen at Refresh Dermatology.
02
Individuals seeking to enhance their skin appearance or address specific skin concerns through microneedling.
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People Also Ask about

Micro-Needling is used for treating the appearance of fine lines, acne scars and improvement of the skin's overall appearance. During this procedure, tiny needles are used to create controlled micro-injuries to the skin in order to produce collagen and elastin.
It's used for treating the appearance of fine lines, acne scars, and the overall improvement of your skin's appearance. During the procedure, tiny needles are used to create a controlled reaction to the skin that allows it to naturally produce collagen and elastin.
The Eclipse MicroPen makes use of a process known as Automated Microneedling, or Collagen Induction Therapy (CIT), to treat fine lines, wrinkles, and acne scars by stimulating production of the skin's own collagen and elastin.
What is a Micropen? The Dermapen is a Microneedling tool consisting of a pen shaped device, powered by a small motor, and equipped with a disposable tip consisting of thin, surgical-grade needles.
Eclipse MicroPen™ is a revolutionary cordless dermal micro-needling device used by skincare professionals all over the world. Eclipse MicroPen stimulates a process known as Micro-Needling, or Collagen Induction Therapy (CIT), to reduce fine lines, wrinkles, and acne scars.
Micro-Needling is used for treating the appearance of fine lines, acne scars and improvement of the skin's overall appearance. During this procedure, tiny needles are used to create controlled micro-injuries to the skin in order to produce collagen and elastin.

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The Refresh Dermatology Eclipse Micropen Patient Consent Form is a legal document that informs patients about the risks, benefits, and procedures involved in receiving microneedling treatments using the Eclipse Micropen device.
Any patient undergoing microneedling treatments at Refresh Dermatology using the Eclipse Micropen is required to fill out and file the consent form prior to the procedure.
To fill out the Refresh Dermatology Eclipse Micropen Patient Consent Form, patients should read the document carefully, provide personal information where indicated, and sign it to acknowledge their understanding and consent to the procedure.
The purpose of the Refresh Dermatology Eclipse Micropen Patient Consent Form is to ensure that patients are fully informed about the microneedling procedure, including potential risks and expected outcomes, and to obtain their consent for the treatment.
The information that must be reported on the Refresh Dermatology Eclipse Micropen Patient Consent Form includes the patient's personal details, a description of the procedure, potential risks and complications, and an acknowledgment of understanding and consent.
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