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


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

Table of Contents for Complete Compliance Package

What Is Included? 

  1. Adverse Event Management Flowcharts 
  2. Acute Infection Biofilm 
  3. Antibody Mediated Edema
  4. Herpes
  5. Inflammatory Nodule 
  6. Intravascular Incident (VO)
  7. Kybella Intravascular Accident 
  8. Non-Inflammatory Nodule 
  9. Retinal Occlusion
  10. B12 
  11. Policy for Standard Administration
  12. Patient Consent 
  13. Supply List
  14. Pre/Post Care
  15. CO2 (Facial, Body, and Vaginal)
  16. Policy for Standard Administration (Facial/Body and Vaginal)
  17. Patient Consent 
  18. Supply List
  19. Pre/Post Care
  20. CoolSculpting 
  21. Patient Consent 
  22. Photo Consent
  23. Treatment Sheet
  24. Pre/Post Care
  25. Cryotherapy
  26. Patient Consent 
  27. Pre/Post Care
  28. Dermal Filler 
  29. Policy for Standard Administration 
  30. Patient Consent
  31. Supply List
  32. Pre/Post Care
  33. Biofilm Management Decision Tree
  34. Herpes Management Decision Tree
  35. Dermaplane 
  36. Policy for Standard Administration
  37. Patient Consent 
  38. Supply List
  39. Elos Plus System (DSL Motif, PL/SRA/SR, LV/LVA, Sublative RF, Sublime) 
  40. Policy for Standard Administration
  41. Patient Consent 
  42. Treatment Sheet
  43. Patient Laser History
  44. Pre/Post Care
  45. Employee Paperwork
  46. Employee Handbook 
  47. Job Application 
  48. Job Descriptions
  49. Employment Agreement
  50. I9
  51. W2
  52. Hydrafacial
  53. Patient Consent 
  54. User Manual
  55. Kybella 
  56. Policy for Standard Administration
  57. Patient Consent 
  58. Supply List
  59. Pre/Post Care
  60. Flowchart for Intravascular Accident Management with Kybella
  61. Local Anesthesia 
  62. Policy for Standard Administration
  63. Patient Consent 
  64. Supply List
  65. Pre/Post Care
  66. Microneedling/Collagen Induction Therapy
  67. Policy for Standard Administration
  68. Patient Consent 
  69. Supply List
  70. Pre/Post Care
  71. Acute Infection Biofilm Adverse Event Management Decision Tree
  72. Neurotoxin
  73. Policy for Standard Administration
  74. Patient Consent 
  75. Supply List
  76. Pre/Post Care 
  77. Herpes Management Decision Tree
  78. Nordlys
  79. Fraxel Patient Consent
  80. IPL Patient Consent
  81. Laser Medical History 
  82. Nordlys Treatment Guidelines
  83. Nordlys User Manual 
  84. Eyewear Table
  85. Nutrient Therapy (IV Therapy, Myers Cocktail) 
  86. Policy for Standard Administration
  87. Patient Consent 
  88. Supply List
  89. Pre/Post Care
  90. Patient Forms
  91. Aesthetic New Patient History
  92. Aesthetic Wishlist
  93. Cancellation/Refund Policy 
  94. Fitzpatrick Skin Scale 
  95. Medical Letter Template
  96. Membership Contract
  97. HIPPA Privacy Policy 
  98. Photo Consent
  99. Release of Records
  100. Pronox
  101. Patient Consent
  102. Treatment Manual
  103. Radio Frequency Microneedling (Profound)
  104. Policy for Standard Administration
  105. Patient Consent 
  106. Supply List
  107. Pre/Post Care
  108. Profound In-Service Instructions 
  109. Profound User Manual 
  110. Profound Treatment Record 
  111. Toxic Dose Calculator
  112. Platelet Rich Plasma (PRP/ Growth Factor Rejuvenation) for Face, Hair, Vaginal 
  113. Patient Consent (PRP and PRP Facelift)
  114. Pre/post Care (PRP and PRP Facelift)
  115. Admin Policy 
  116. Supply List 
  117. Quality Assurance
  118. Quality Assurance Checklist
  119. Sclerotherapy
  120. Treatment Sheet
  121. Policy for Standard Administration
  122. Patient Consent 
  123. Supply List
  124. Pre/Post Care
  125. Sculptra
  126. Treatment Sheet
  127. Policy for Standard Administration
  128. Patient Consent 
  129. Supply List
  130. Pre/Post Care
  131. Semaglutide (Wegovy)
  132. Policy for Standard Administration
  133. Patient Consent 
  134. Compounding Pharmacy Vendor Information
  135. Monthly Membership Contract for Clients
  136. Medical History Intake Form for Primary Consultation
  137. Skin Growth Removal + Subcision
  138. Pre/Post Care for Skin Growth Removal
  139. Patient Consent (Skin Growth Removal + Subcision)
  140. Standard Operating Policies
  141. Acute or Infectious Communicable Diseases
  142. Administering Medications
  143. Adverse Consequences and Medication-Related Problems
  144. Allergic Reaction
  145. Autoclave Sterilization
  146. Bloodborne Pathogens Occupational Exposure
  147. Bomb Threat Procedure
  148. Chemical Inventory
  149. Contaminated Needle Stick HIV/HIB Awareness
  150. Controlled Substances
  151. Discarding and Destroying Medications
  152. Disposal of Blades, Glass, Needles, Sharps, and Syringes
  153. Drug Recalls
  154. Earthquake Safety Procedure
  155. Emergency Procedure/Transfer Protocol
  156. Fire Safety Procedure
  157. Germicides Used In Facility
  158. Hand Scrub Technique
  159. Handling of Biohazardous Wastes
  160. Identifying and Managing Medication Errors and Adverse Consequences
  161. Impaired Healthcare Provider
  162. Incident Reports
  163. Infection Control Introduction
  164. Infection Control Program
  165. Infection Log
  166. Infectious Disease Program
  167. Labeling of Medication Containers
  168. Linen
  169. Medication Charting
  170. Patient Transfer Form
  171. Performing Injections
  172. Record Keeping
  173. Security
  174. Sharps Injury Policies
  175. Spor-Test or Attest
  176. Sterile Packs
  177. Storage of Medications
  178. Traffic Control
  179. Treatment Rooms
  180. Universal Precautions Policy
  181. Wound Infections
  182. User Manuals Included For:
  183. Core
  184. Elos Plus
  185. Hydrafacial
  186. Profound RF
  187. Nitrous Oxide 
  188. Vascular Occlusion
  189. Vascular Occlusion Policy 
  190. Hyaluronidase (Hylenex) Patient Consent 
  191. Vascular Occlusion Adverse Event Decision Tree 
  192. Retinal Occlusion Adverse Event Decision Tree 
  193. Tara's Complete Doctoral Dissertation regarding Vascular Occlusion
  194. Zo Skincare Protocols and Chemical Peels
  195. 3 Step Peel Consent 
  196. Zo Chemical Peel Policy for Standard Administration
  197. Supply List
  198. Pre/Post care

ZO Skincare ProgramsWithin each Standard Administration Policy is 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 

Within each Treatment Consent is the following key items: 

- About the Procedure 

- Contraindications 

- Limitations 

- Pregnancy, Neurological, Allergies 

- Pre/Post Care 

- Photographs 

- Payment 

- Results 

- Consent to treatment 

- Additional signature page to have the patient resign every time they are treated

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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