Please print and fill out all forms and bring them to the office with you at the time of your appointment.
Please select the correct procedure link, print, and fill out all forms. Email signed consents (email below) or fax to (985) 386-2698.
Our practice often utilizes before and after photos or videos taken of medical and/or cosmetic procedures and treatments for internal and commercial uses. Please be aware that patients will not be compensated for the use of any image(s) for which they have given permission to Integrated Dermatology of Ponchatoula, LLC, doing business as Benson Dermatology, QnA Cosmetic Surgery, and QnA Medical Spa, (collectively, “Integrated”) to use for marketing purposes. Patient’s identities may be concealed by obstructing areas of the face and/or body.