Please note: These forms are intended for the use of clients and patients of Dr. Kents and Medical Aesthetics of Muskoka. In order to complete the forms, please download them to your personal device. Some forms can be completed electronically, however you are still required to initial or sign the forms. If you have an electronic signature, feel free to use that; otherwise, you will be required to initial the form in a pen and paper format (which may require the use of a printer/scanner). Completed consents and forms should be emailed or faxed to the clinic. Alternately, they can be dropped off or mailed to the clinic.
New dermatology referrals must complete the Patient History Form prior to receiving an appointment.
Patient Hx Form
Dermatology Patients – REQUIRED
This form must be fully completed and returned to MAOM prior to the scheduling of a NEW dermatology appointment. Be sure to read/review the other three (3) required forms, as indicated in the document.
Virtual Care Policy
All Patients – REQUIRED
Virtual care (video conferences, email and telephone consults) appointments ensure that we can continue to care for our patients safely and effectively, while minimizing in-clinic time. Many follow-up appointments are completed by virtual care. Dermatology patients must acknowledge reading this document on their Patient History Form.
Client Intake Form
Aesthetic Medicine Clients – REQUIRED
New aesthetic medicine clients are required to complete this form. Dr. Kents will review your information and discuss treatment options during your virtual consultation.
Bland Skin Care
All Patients/Clients – OPTIONAL
Many skin conditions can be improved by switching to a Bland Skin Care routine. This document lists a number of options for safe products to use (skin care, hair care, make-up and laundry essentials).
Sun Safety
All Patients – OPTIONAL
UV radiation can exacerbate certain skin conditions. It also contributes to photo aging and skin cancer. These tips and product suggestions will help protect you and your skin.
Derm Clinic Policies
All Patients – REQUIRED
Please review our clinic policies before your visit. Dermatology patients must acknowledge reading the form prior to having an appointment scheduled, and confirm having read the policies on their Patient History Form.
Photography/Email Consent Policy
All Patients – REQUIRED
Photographs are primarily used in dermatology and aesthetic medicine to document conditions and their treatment progress. Photos are kept securely in patient’s secure electronic medical records, and are never shared without consent. Dermatology patients must acknowledge completing this consent on their Patient History Form.
Photography Tips
All Virtual Care Patients – OPTIONAL
In order to help Dr. Kents assess your skin during virtual consults, it is important that we have quality photographs of your condition. You may find these tips helpful.
Wound Care
Dermatology Patients – OPTIONAL
After having a procedure (biopsy, excision, etc.) at MAOM, you will receive wound care instructions to outline what you can expect and tips to implement during wound healing. This is a copy of that form.