SunCoast Plastic Surgery Ultherapy Consent Form 2012-2026 free printable template

Patient Name printed Date of Birth Patient Signature Date Witness Signature Ultherapy Consent Form - Revised 7/2012. Swetanshu Chaudhari MD 400 W* Parkwood Ave Ste 116 Friendswood TX 77546 832 398-0112 Patient Consent Form In considering an Ultherapy treatment with the Ulthera system please read the following information carefully and discuss any questions you may have with your physician* Ultherapy utilizes the Ulthera system which is cleared by the FDA for use as a non-invasive face and...

How to fill out SunCoast Plastic Surgery Ulformrapy Consent Form

How to fill out SunCoast Plastic Surgery Ultherapy Consent Form

1. Start by obtaining the SunCoast Plastic Surgery Ultherapy Consent Form from the clinic or their website.
2. Read the form thoroughly to understand the purpose of the procedure and any associated risks.
3. Fill in your personal information, including your name, address, contact number, and date of birth.
4. Indicate the specific procedure you are consenting to, which in this case is Ultherapy.
5. Review the section outlining the potential risks and benefits of the procedure.
6. Acknowledge that you have been informed about the procedure and its alternatives by signing the designated area.
7. If applicable, fill in any medical history details requested to ensure the procedure is safe for you.
8. Complete any additional consent areas as required, such as photography or sharing medical information.
9. Ensure all information is accurate before submitting the form back to the medical office.

Who needs SunCoast Plastic Surgery Ultherapy Consent Form?

1. Individuals considering Ultherapy treatment at SunCoast Plastic Surgery need to fill out the consent form.
2. Patients seeking to understand their treatment options and potential risks associated with non-invasive skin-lifting procedures should complete this form.

People Also Ask about

Why is Ultherapy so expensive?

The biggest factor in the cost for Ultherapy treatment is the size of the treatment area. This FDA-approved skin tightening treatment addresses loose skin on the face and neck, from brows to jowls to the décolletage. Larger areas simply take longer to treat, increasing your Ultherapy price.

What is a contraindication for Ultherapy?

The Ulthera System is contraindicated for use in patients with: Open wounds or lesions in the treatment area. Severe or cystic acne in the treatment area. Active implants (e.g., pacemakers or defibrillators), or metallic implants in the treatment area.

What not to do before Ultherapy?

What Should I Avoid Before Ultherapy? Do not use blood-thinning medications and supplements. Avoid direct sun exposure three to five days before treatment. Shave desired treatment area if necessary. Discontinue use of Retinol, glycolic acid, and salicylic acid.

What should I avoid before Ultherapy?

Avoid blood thinners and heavy alcohol 2 weeks prior to treatment. Avoid Botox at least 1 week prior to treatment. Avoid Dermal Fillers at least 4 weeks prior to treatment. Please make sure you eat a small meal prior to treatment if you elect to receive narcotics for pain or a sedative for anxiety.

Who is not a good candidate for Ultherapy?

If patients have skin that is very lax, often the case for older people, then Ultherapy may not provide satisfactory results. In those cases, facelift surgery would be recommended for effective treatment.

Is Ultherapy safe for everyone?

One of the greatest benefits of Ultherapy is that it's a non-invasive procedure. This means there are no incisions or anesthesia involved. And unlike many laser treatments, Ultherapy doesn't target melanin, meaning it's safe for all skin types.

How common is nerve damage from Ultherapy?

Though Ultherapy is a common procedure and is considered very safe, there are still potential side effects. These can include pain and swelling in the treated areas, and in rare cases also numbness or nerve damage. These side effects are rare and, in most cases, very short-lived.

Who is not a candidate for Ultherapy?

People With Health Conditions. Although this technique is very easy, it is not right for everyone. In particular, you should not use this treatment if you are pregnant. Further, you may not be a good candidate for this ultherapy treatment if you have extremely lax skin or significant sun damage.

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What is SunCoast Plastic Surgery Ultherapy Consent Form?

The SunCoast Plastic Surgery Ultherapy Consent Form is a document that patients must sign to acknowledge their understanding of the Ultherapy procedure, its potential risks, and benefits before undergoing treatment.

Who is required to file SunCoast Plastic Surgery Ultherapy Consent Form?

Patients who are seeking Ultherapy treatment at SunCoast Plastic Surgery are required to file the Ultherapy Consent Form.

How to fill out SunCoast Plastic Surgery Ultherapy Consent Form?

To fill out the SunCoast Plastic Surgery Ultherapy Consent Form, patients should read the document carefully, provide personal information, acknowledge understanding of the procedure, and sign and date the form.

What is the purpose of SunCoast Plastic Surgery Ultherapy Consent Form?

The purpose of the SunCoast Plastic Surgery Ultherapy Consent Form is to ensure that patients are informed about the Ultherapy procedure, including its risks and benefits, and to obtain their consent to proceed with the treatment.

What information must be reported on SunCoast Plastic Surgery Ultherapy Consent Form?

The information that must be reported on the SunCoast Plastic Surgery Ultherapy Consent Form includes patient demographics, medical history, a detailed explanation of the Ultherapy procedure, potential risks and side effects, and the patient's signature and date.