Patient Forms | Clariday Aesthetics

Patient Forms

Clariday Aesthetics understands that our patients want to have their office visit be as smooth as possible. To help facilitate this process, we have provided our patient forms online. You may print and complete the following forms, then bring them to your appointment. This saves you the effort of filling out the form after you get to the office.

Note: You will need Adobe Acrobat Reader to view these forms. Click here to download a free version of Acrobat Reader

	Aesthetic Forms
	New Patient Information and Acknowledgment Form
	Patient Consent Form – Restylane
	Patient Consent Form – IPL (Intense Pulse Light)
	Patient Consent Form – Laser Hair Removal
	Patient Consent Form – Botox / Dysport
	Patient Consent Form – Massage

	Medical Forms
	HIPAA – Notice of Privacy Practices
	CO2 Surgery Instructions
	Blepharoplasty Surgery Instructions
	Dr. Clariday Medical Information Form
	Medical Information & Insurance Form

Things to Remember for your Appointment:
•	Parents must accompany children under the age of 18 in order to complete and sign the necessary paperwork.
•	Arrive 10-15 minutes early to allow time for the check-in process.
•	Bring the following items with you:
	•	Photo Identification
	•	Insurance Card (medical and vision, if applicable)
	•	Any relevant medical records for existing conditions related to eye care
	•	Doctor Referral Form – (If applicable)

Please note: Though we try to adhere to your scheduled appointment time, emergency "work-ins" or unforeseen problems may occur and cause your doctor to run behind schedule. If the front desk is aware of any such circumstances, you will be notified at the appropriate time.