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Hyaluronan / Scar / Acne vulgaris / Plastic surgery / Oral and maxillofacial surgery / Oral surgery / Juvéderm / Restylane / Glycosaminoglycans / Medicine / Surgery


Your AADFA Certified Dentist is: PATIENT HISTORY AND CONSENT FORM – DERMAL FILLER For your safety and comfort, please answer the following medical questions accurately. Please discuss anything you are unsure of with y
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Document Date: 2015-03-11 21:22:47


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City

Dysport / /

IndustryTerm

injection site / /

MedicalCondition

post-operative headache / eaton-lambert syndrome / pain / Allergies / multiple sclerosis Cheloid/Hypertrophic / Servere allergy / nausea / Anaphylaxis Herpes Acne Skin cancer / local muscle weakness / myasthenia gravis / rarely serious allergic reaction/anaphylaxis / skin necrosis / /

MedicalTreatment

dermabrasion / Botox / Antibiotics / /

Position

Your AADFA Certified Dentist / AADFA Certified Dentist / Dentist / /

Product

Sodium Chloride / /

Technology

laser / /

SocialTag