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How to use or fill out Ultherapy Consult Record - Heartland Dermatology & Skin

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Click ‘Get Form’ to open the Ultherapy Consult Record in our editor.
Begin by entering your personal information, including your name, date, age, weight, and height. This foundational data is crucial for your consultation.
Carefully review the medical and surgical history section. Indicate any relevant conditions by selecting 'YES' or 'NO' for each item listed. This helps your clinician assess your suitability for Ultherapy.
In the self-exam section, score each clinical factor based on your current health status and treatment goals. This will guide your physician in tailoring the best approach for you.
Complete the medication list by detailing any prescriptions or supplements you are currently taking. If none, check the designated box.
Finally, ensure all signatures are collected at the bottom of the form from both you and your healthcare provider before submission.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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What insurance does Heartland Dermatology accept?

I understand Heartland Dermatology Center is a participating provier with BC/BS, Medicare, PHC, Coventry, WPPA, UHC Kancare, United Healthcare, HPK Network, and TriCare.

Does Jennifer Aniston do Ultherapy?

Answer: Alternatives to Ultherapy One possible alternative to Ultherapy would be micro needling using radio frequency. There are a variety of devices that could do this, but I use the Morpheus8 system. This treatment would target the skin to produce some tightening. Another option would be Face/NeckTite.