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הסכמה להחלקת עור בלייזר

הסכמה מודעת לטיפול בהחלקת עור אבלטיבית וללא אבלטיבית כולל פרקציונלי CO2, ארביום וקילופים בלייזר פחמן

נסה את הטופס שלקוחותיך יראו

מלא את הטופס כפי שלקוחותיך יעשו — כל שדה, כל שאלה תנאית, כל סימן התנגדות. לא נשמר ולא נשלח.

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הסכמה להחלקת עור בלייזר

פרטי הלקוח

פרטי הטיפול

היסטוריה רפואית

סיכונים וסיבוכים

Potential Risks and Complications:

- Redness, swelling, oozing, and crusting for several days (ablative) or 1–3 days (non-ablative); redness can persist for weeks
- Pain or burning during healing
- Infection — bacterial, viral (cold sore flare), or fungal
- Hyperpigmentation — darkening, common in tanned or darker skin, usually fading over months
- Hypopigmentation — lightening that can be permanent, especially with deep ablative treatment
- Prolonged redness, milia, or acne flare
- Scarring, including textured or thickened scars (rare)
- Eye injury without protective eyewear
- Lines of demarcation between treated and untreated skin

Strict sun avoidance and SPF 30+ for 4 weeks before and 8 weeks after is essential. Ablative resurfacing requires a wound-care routine for 5–10 days and time off work.
I understand the expected healing process, that I must follow the wound-care and sun-protection instructions exactly, and that healing may take longer than described.
I understand that temporary or permanent skin lightening or darkening, prolonged redness, and scarring are possible, particularly with recent sun exposure, isotretinoin, or a history of pigmentation.

שחרור צילום

הסכמה וחתימה

I voluntarily consent to laser skin resurfacing treatment. I have been informed of the benefits, risks, alternatives, and potential complications, including infection, pigment change, and scarring. I understand this is an elective cosmetic procedure and no guarantee of outcome has been made. I release the provider and practice from liability related to this treatment except in cases of negligence.
I confirm I have read and understood the above information and give my informed consent.
חתום למעלה באצבע או בעכבר

תצוגה בלבד — לא נשמר, לא נשלח ולא מאוחסן.