Get Ultherapy Consent Form

The consent form should describe if/when identifiable data will be destroyed and how such data will be protected and how it will be used or shared. Language - Consent forms should be written in the 2nd person (i.e., "you are") and in a language that is clear, concise, and understandable to the subject population.

The consent form should include the following statements: I understand that my participation is voluntary, that I can choose not to participate in part or all of the project, and that I can withdraw at any stage of the project without being penalized or disadvantaged in any way. I agree to take part in this study.

I (patient name) give permission for [practice name] to give me medical treatment. I allow [practice name] to file for insurance benefits to pay for the care I receive. I understand that: [practice name] will have to send my medical record information to my insurance company.

Post Treatment Instructions for Ulthera Wash skin with cool water and a gentle cleanser. No other harsh products for one week. If the skin is slightly pink or red in areas following the treatment, avoid hot water when washing or showering until the 'blush' has subsided (usually within an hour).

The following are the required elements for documentation of the informed consent discussion: (1) the nature of the procedure, (2) the risks and benefits and the procedure, (3) reasonable alternatives, (4) risks and benefits of alternatives, and (5) assessment of the patient's understanding of elements 1 through 4.

People With Health Conditions. Although this technique is very easy, it is not right for everyone. In particular, you should not use this treatment if you are pregnant. Further, you may not be a good candidate for this ultherapy treatment if you have extremely lax skin or significant sun damage.

How do you write a consent form? Use language that makes sense to your audience. Be conversational and direct, and avoid industry jargon. Write in the second person. Consent forms should directly address participants, using “you,” “your child,” etc. Minimize passive voice.