Let Us Help You Build Your Empire...



Every Form You Ever Needed to Run Your
Aesthetics Practice With Confidence and Compliance


This package of customizable forms for your practice goes beyond just patient intake and treatment consent forms. We include every form we use here at Delle Chiaie Cosmetic Medicine from our employee handbook to treatment policies and administration procedures.


Perfect for new aesthetics practices and solo injectors, every form is offered in compatible formats with Pages and Word, and can be customized with your logo and medical director's name. We update these forms constantly based on our own experiences so you can benefit from the observations of a seasoned medical aesthetic practice as well as your own!



Spend your time and energy perfecting your

technique and improving your patient results, not on making sure you are legally covered in case of

complications.


It is not a question of if, but when.

Weather is is a dissatisfied patient or a vascular occlusion, legally complex situations befall even the most experienced of providers. The consequences of these situations can be severe and legally devastating to an injector's practice and reputation. Don't run the risk of loosing everything you worked so hard to achieve by not ensuring you are covered.


Compliance Package Table of Contents


Part 1: Policy for Standard Administration


Within each Standard Policy are the following key items:

  • Purpose
  • Setting 
  • Supervision
  • Record Keeping
  • Training and Education
  • Evaluation and Competency
  • Authorized Personnel Documentation
  • Limitations
  • *System Operation if applicable
  • Procedural Steps
  • Pre & Post Treatment
  • Development of Plan

Policy for Standard Administration List

  1. B12
  2. CO2
  • Facial/Body
  • Vaginal
  1. Dermal Filler
  • Hyaluronic Acid Insertion
  • Vascular Occlusion 
  • Hyaluronidase
  1. Dermaplane
  2. Elos Plus System
  • DSL Motif
  • IPL/SRA/SR
  • LV/LVA
  • Sublative RF
  • Sublime
  1. Kybella
  2. Local Anesthesia
  3. Microneedling/Collagen Induction Therapy
  4. Nutrient Therapy
  5. Platelet Rich Plasma (PRP or Growth Factor Rejuvenation)
  • Face/tear Troughs
  • Hair
  • Vaginal
  1. Profound Radio Frequency
  2. Sclerotherapy
  3. Zo Chemical Peels


Part 2: Treatment Consents

What you can you expect in each consent:

  • About the Procedure
  • Contraindications
  • Limitations
  • Pregnancy, Neurological, Allergies
  • Pre/Post Care
  • Photographs
  • Payment
  • Results
  • Consent to treatment
  • Additional signature page to have the client resign every time they are treated

Treatment Consents List:

  1. B12
  2. CO2
  • Facial/Body
  • Vaginal
  1. Dermal Filler
  2. Dermaplane
  3. Elos Plus System
  • DSL Motif
  • IPL/SRA/SR
  • LV/LVA
  • Sublative RF
  • Sublime
  1. Hydrafacial
  2. Kybella
  3. Local Anesthesia
  4. Microneedle/Collagen Induction Therapy
  5. Nitrous Oxide
  6. Nutrient Therapy
  7. Platlet Rich Plasma
  • Face/tear Troughs
  • Hair
  • Vaginal
  1. Profound Radio Frequency
  2. Sclerotherapy
  3. Zo Chemical Peels

Part 3: Pre and Post Care Sheets

Pre and Post Care Sheets Included For:

  1. B12
  2. CO2
  • Facial/Body
  • Vaginal
  1. Dermal Filler
  2. Elos Plus System
  • DSL Motif
  • IPL/SRA/SR
  • LV/LVA
  • Sublative RF
  • Sublime
  1. Kybella
  2. Microneedle/Collagen Induction Therapy
  3. Nutrient Therapy
  4. Platlet Rich Plasma
  • Face/tear Troughs
  • Hair
  • Vaginal
  1. Profound Radio Frequency
  2. Sclerotherapy
  3. Zo Chemical Peels


Part 4: Supply Lists

Treatment Supply Lists Included For:

  1. B12
  2. CO2
  3. Dermal Filler
  4. Dermaplane
  5. Kybella
  6. Microneedle/Collagen Induction Therapy
  7. Nutrient Therapy
  8. Neurotoxin
  9. Platlet Rich Plasma
  10. Profound Radio Frequency
  11. Sclerotherapy
  12. Zo Chemical Peels


Part 5: Employee Forms

Employee Forms Included For:

  1. Blood Born Pathogen Policy
  2. Data Breech
  3. Employee Handbook
  4. Esthetician Compensation
  5. I9
  6. Job Application
  7. Privacy Policy
  8. W2


Part 6: Patient Intake Forms

Patient Intake Forms Included For:

  1. Refund Policy
  2. Photo Consent
  3. Membership Contract
  4. Fitzpatrick Scale
  5. HIPPA


Part 7: User Manuals

User Manuals Included For:

  1. Core
  2. Elos Plus
  3. Hydrafacial
  4. Profound RF
  5. Nitrous Oxide 


DCCM™ Practice Owner: Tara Delle Chiaie, MSN, FNP-BC, APRN


Tara has been in medicine since 2002 as a Registered Nurse. In 2011 she graduated from the accelerated program at the University of New Hampshire (UNH) as an Advance Practice Registered Nurse (APRN) and immediately became nationally recognized through the American Nurses Credentialing Center (ANCC) as a Board Certified Nurse Practitioner. She is further Board Certified in Anti-Aging Medicine by the American Academy of Anti-aging Medicine. Growing up in the beauty industry she found it was a great union to blend beauty with medicine. She has an astute sense of safety while her experience guides her practice to produce beautiful and natural results. She has been teaching nursing and medicine for almost 15 years. Sharing her knowledge and helping others define their talent brings her great joy. Tara’s goal is to continually fine tune the art of bringing one's inner beauty to the Surface. This happens by increasing her own education as well as ensuring other health care providers are delivering the same quality of care.


In 2013 Tara opened her Cosmetic business, Delle Chiaie Cosmetic Medicine. Although aesthetics is her passion she found a significant flaw in the health care system and then opened a concierge medical practice; Delle Chiaie Concierge Medicine. Although Tara created her initial business with a strict business plan; she always kept one ear to the ground listening and recognizing the environment around her. This was so she could ensure her organic growth within the industry and being mindful of patient need and economic trends. After seeing several hundreds of clients that needed correction work she quickly realized it was an opportunity to begin teaching others. Creating DCCM Academy was her way to share her experience and knowledge with others while safeguarding patients from the ill informed or the undereducated provider.

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