About this template
This Skin Tag Removal Consent Form is essential for medical spas, dermatology clinics, and skin care professionals performing minor skin procedures. The form captures critical patient information, verifies contact details, collects essential medical history regarding skin growths, and secures formal acknowledgment of the procedure's risks, benefits, and aftercare.
Transitioning to a digital consent process ensures your clinic gathers legible, time-stamped acknowledgments before any procedure begins. Patients can conveniently review disclosures and complete the questionnaire from their phone or computer prior to arriving at the clinic, reducing front-desk bottlenecks and eliminating paper clutter.
Key features
- Collect digital patient consent prior to procedures
- Gather essential contact and emergency details
- Document acknowledgment of risks and aftercare instructions
- Accessible on any mobile device, tablet, or desktop
Use cases
- Dermatology clinic pre-procedure processing
- Medical spa aesthetic treatments and consultations
- Specialized skin care and mole/tag assessment clinics
What this form collects
- Full Legal Name (Short answer)Enter your first and last name as it appears on your government-issued ID.
- Date of Birth (Date)Please enter your date of birth.
- Email Address (Short answer)Where can we send your aftercare instructions and appointment confirmation?
- Phone Number (Short answer)Enter the best phone number to reach you regarding your appointment.
- Home Address (Paragraph)Enter your full residential address.
- Location of Skin Tag(s) (Short answer)Specify where on your body the skin tag(s) to be removed are located.
- Do you have a history of abnormal scarring or keloids? (Multiple choice)Keloids are raised, overgrown scars that can form after skin trauma.
- Are you currently taking blood thinners or anticoagulants? (Multiple choice)Medications such as aspirin, warfarin, or other blood thinners can affect bleeding during removal.
- Do you have any known allergies to local anesthetics, latex, or topical ointments? (Short answer)List any relevant allergies or write 'None'.
- Acknowledgment of Risks and Consent (Multiple choice)I understand the nature of the skin tag removal procedure, potential risks including minor scarring or irritation, and agree to proceed with the treatment.
- Client Signature (Full Name) (Short answer)By typing your full name below, you confirm that all information provided is accurate and serve as your digital signature.
- Date of Signature (Date)Select today's date.
FAQ
How can I share this consent form with my patients?
You can easily share the form via a direct link in appointment confirmation emails, embed it on your clinic website, or have patients fill it out on a tablet in your waiting room.
Can I customize the questions for other skin treatments?
Yes! Once you instantly generate this form in your Google Drive, you can fully edit, add, or remove questions to fit any aesthetic or minor dermatological procedure.
Is this form mobile-friendly for patients?
All Google Forms automatically adapt to mobile devices, allowing patients to review and submit their information smoothly from their smartphones.
How do I store and organize completed patient responses?
All submissions are automatically saved to a linked Google Sheet, giving you an organized, searchable log of every client's submitted consent and contact details.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.