Intense Pulse Light Forms
 
 

Fitzpatrick Scale - Determines what Skin type you have and will help to determine you IPL settings

Intense Pulse Light (Skin Worksheet) - Helps you to advise DCI on your skin type and helps the provider to determine IPL settings

Consent Form - Allows DCI to perform the IPL procedure

Medical Form - Specific information needed by providers before they can do procedure

Post Instructions - a take home form for patients to help with skin care after IPL

ABN - Release of insurance billing (we can not bill insurance for cosmetic procedures)

 

 

 



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