Protocol and Forms

Review and download all your forms here. If you have any questions, make note of them and we can discuss them at your appointment, or give us a call. We appreciate you taking the time to be prepared for your appointment.

INTAKE FORM

MUST FILL OUT PRIOR TO CONSULT
Please complete this form and bring to your consultation meeting.
DOWNLOAD PDF FORM


PROTOCOL FORMS

Please complete applicable forms and bring to your appointment.

ULTHERAPY

Please complete this form and bring to your consultation meeting.
VanLaser-Protocol-Ultherapy

LASER / MICRODERM / CHEMICAL PEEL

Please complete this form and bring to your consultation meeting.
VanLaser-ProtocolLaserMicrodermChemPeel

INJECTABLES / FILLERS / BOTOX

Please complete this form and bring to your consultation meeting.
VanLaser-Protocol-InjectablesDermalFillersBotox

 


 

PROTOCOL

Laser, Microderm, and Chemical Peel Treatment

  • No Accutane (Acne Medication) 1 year prior to treatment.
  • Not pregnant or nursing.
  • If you have ever been diagnosed or have a history with cold sores (HSV) medication may be recommended prior to treatment.
  • Shave the area you wish to have treated one day prior to treatment for hair removal
  • Discontinue using the following products 2 weeks prior to treatment:
    – Topical Prescriptions
    – Retinols/ Retinoids: Obagi Tretinoin & Refissa
    – Photo Sensitive Medications
  • Discontinue using the following 3 days prior to treatment and 3 days after treatment:
    – AHA’s
    – Glycolic Acids, Salicylic, & Benzyl Peroxide
    – Obagi Clear, Blender, & Hydroquinone or Lightening Creams
    – Any exfoliating products
    – Chemical depilatories
    – Epionce Lytic products
    – No self-tanners 2 week prior/ 1 week post
    – No heavy sun exposure 4 weeks prior/ 4 weeks post
    – No sun beds 4 weeks prior/ 4 weeks post
    – Waxing/ Tweezing 4 weeks prior/ 4 post
    – No hot tubs or hot showers 48 hrs. post treatment
  • Injections:
    – No botox injections 7 days prior to treatment
    – No derma fillers 14 days before treatment
    – Botox and derma fillers can be injected following your treatment.
  • No exercise 24 hours post treatment.