Forms

Medical Patient Paperwork
These forms should be completed by new patients and returned to the office AT LEAST 48 hours prior to your appointment via fax or dropping them off. They may be faxed to 618-288-6906.

Pediatric Patient Registration (16 and younger)
Patient Registration (17 and older)

Aesthetic Patient Paperwork
These forms are the initial forms to be filled out by any aesthetic or skin care patient before the time of appointment.

New Client Info
 Ooh La La Privacy Notice
 itzpatrick Skin Type Questionaire
Consent for Photos
Office Policies

Botox Treatment
If a patient is getting Botox Cosmetic for the first time they will need to fill out the 2 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Botox Consent Form
Botox Pre &Post Care Instructions

Dermal Fillers
If a patient is getting a Dermal Filler (Radisse/Juvederm) for the first time they will need to fill out the 2 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Dermal Filler Consent
Dermal Filler Pre & Post Care Instructions

Chemical Peel
If a patient is getting a Chemical Peel for the first time they will need to fill out the 1 attached document.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Chemical Peel Consent

Hair Removal
If a patient is getting a Laser Hair Removal for the first time they will need to fill out the 3 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Laser Hair Removal Consent
Laser Hair Removal Pre & Post Care Instructions
Laser Hair Removal - What to Expect

IPL or Limelight
If a patient is getting a IPL or Lime Light treatment for the first time they will need to fill out the 2 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

IPL or Lime Light Consent
IPL or Lime Light Pre & Post Care Instructions
IPL or Lime Light What to Expect

Titan Laser Treatment
If a patient is getting a Titan Laser Treatment for the first time they will need to fill out the 1 attached document.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Titan Laser Consent
Titan Laser Pre & Post Care Instructions

Laser Vein Treatment
If a patient is getting Laser Vein Treatment for the first time they will need to fill out the 2 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Laser Vein Treatment Consent
Laser Vein Treatment Pre & Post Care Instructions

Laser Genesis
If a patient is getting Laser Genesis treatment for the first time they will need to fill out the 2 attached documents.
NOTE: If the 5 Basic Documents have not been completed by the patient, they will need to complete them as well.

Laser Genesis Consent
Laser Genesis Pre & Post Care Instructions

The Pearl
Pearl Pre Treatment Instructions