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Patient Profile Forms and Instructions

Creating comprehensive patient files

PCA SKIN® provides you with essential forms to be used in creating patient files. Using these forms will help build your relationship with the patient, gather necessary information to develop effective daily care regimens and treatment plans, and most importantly, ensure patient results.

The following consultation forms are available from PCA SKIN®:

Patient Profile Forms

  • New patient procedure checklist

    PDF 157.5KB

    Highlights important information to be covered prior to a treatment and gives the clinician the order in which each step should take place (analyzing the skin, determining the appropriate daily care regimen, scheduling the patient’s first treatment, etc.). We recommend that you charge for a consultation. Following this checklist ensures that patients get the most out of their consultation and that you are armed with all the necessary information to make the best daily care and professional treatment recommendations for your patients.

  • Patient profile

    PDF 271.8KB

    Provides for full disclosure of pertinent patient information, which will enable the clinician to determine an appropriate treatment plan and daily care regimen. Have your patients review this prior to each treatment to ensure they have not changed medications, topicals, procedures, etc.

  • Consent form

    PDF 205.5KB

    The patient signs and dates prior to their appointment, stating they consent to the treatment that will be performed on them that day. An oral agreement to treatments is not sufficient for your protection. In addition, they agree to have a clear understanding of expectations and have followed all pre- and post-procedure recommendations. Have patients review prior to each appointment, and initial and date to re-consent.

  • Face diagram

    PDF 135.9KB

    Used to document specific areas of concern or areas the clinician has addressed. It is best to take before and after photographs. The Face Diagram can be used in addition to photos or in place of them if photographic equipment is not available to the clinician.

  • Patient Treatment Log

    PDF 301.9KB

    Used to document data regarding the treatment performed (the specific products used in the treatment protocol, number of layers applied of the chemical peel, sensitivity of patient during the treatment, any visible signs of trauma, etc ).

Patient Instructions

  • Preparation for a Peel Treatment

    PDF 211.5KB

    Educates the patient on lifestyle considerations prior to their scheduled treatment. This will help ensure patient compliance and reduce the incidence of complications following treatment.

  • Rx Treatment Plan

    PDF 1821.2KB

    Helps you customize a regimen using this prescription pad. For condition-specific daily care regimens refer to the Daily Care Solutions for Specific Conditions section of the textbook.

  • Post-Procedure Skin Treatment Tips

    PDF 341.7KB

    Provided to the patient following treatment. It is important to review these tips with the patient prior to their leaving the practice. This will help ensure they have a clear understanding of their post-procedure process.