SURGERY FORMS & CONSENTS

Please click on the links below to download the forms.

• Surgery Scheduling Deposit Form
• Credit Card Authorization Form
• Northwest Hospital Pre-Operative form
• Bellona Surgery Center: Medicare & Insurance Consent Form
• Bellona Surgery Center: Patient Privacy
• Bellona Surgery Center: Patient Rights & Responsibilities

MEDSPA FORMS & CONSENTS

Please click on the links below to download the forms.

GENERAL FORMS:

Skin Care Client Information Form

PEELS:

Chemical Peel Consent Form

Obagi Blue Peel Consent Form

SkinMedica Peels Consent Form

Vi Peel Consent Form

B Liftx Treatment Consent Form

Glycolic Acid Treatment Consent Form

MICRODERMABRASION:

Microdermabrasion Consent Form

LASERS:

Laser Genesis Consent Form

IPL Consent Form

Pearl Consent Form

Titan Consent Form

Laser Hair Removal Consent Form

Vascular Lesions Consent Form

Laser Tattoo Removal Consent Form

INJECTABLES:

Patient Information for Botox and Fillers

Juvederm® Utra Consent Form

Botox® and Dysport Consent Form

Radiesse Consent Form

LASHES:

Latisse™ Consent Form

OTHER:

Accent XL Consent Form

Waxing Consent Form

CALL 410.296.0414

Cosmetic Consultations are Complimentary!