Cosmetic Intake Form - Romagosa Dermatology Group: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information, including your name, date of birth, and today's date. Ensure accuracy for effective communication.
Provide your email address and indicate whether you consent to receive promotional emails regarding cosmetic events. This helps keep you informed about special offers.
Identify who referred you for consultation by checking the appropriate box and filling in any additional details if necessary.
Answer the medical history questions regarding breastfeeding, medications that may increase bleeding risk, keloid scarring, and previous cosmetic procedures. Be honest to ensure safe treatment options.
Detail your current skincare regimen and specify which services you are interested in discussing during your consultation by checking all applicable boxes.
Indicate your interest in seeing an aesthetician for further skin care discussions by selecting yes or no.
Review the photography consent section carefully. Circle your preferences regarding the use of before and after photographs for educational or marketing purposes.
Finally, sign and print your name at the bottom of the form to confirm your consent and understanding of the information provided.

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Whats the difference between cosmetic and medical dermatology?

Dermatology is an area of medicine that focuses on medical conditions affecting the skin. Cosmetic dermatology also known as aesthetic medicine is a subspecialty within dermatology that helps patients improve their skin, hair, and nails for cosmetic (aesthetic) purposes, rather than for health reasons.

Can you see a dermatologist for cosmetic reasons?

Cosmetic dermatology can be used to address age spots and dark marks, cellulite and fat removal, hair removal, scars and stretch marks, wrinkles, tattoo removal and promote younger-looking skin.

How to be a cosmetic dermatologist?

First, check their credentials and experience. Board-certified dermatologists, like Dr. Lisa Silbret and Dr. Alan Schechter, have undergone extensive training in skin health and cosmetic procedures, ensuring they are qualified to provide expert care.