Pre-Procedure Information
Emergency Contact Information
- Primary Emergency Contact Name: _________________
- Relationship: _________________
- Phone Number: _________________
- Secondary Emergency Contact: _________________
Medical Information
- Blood Type: _________________
- Known Allergies: _________________
- Current Medications: _________________
- Primary Care Physician: _________________
Emergency Response Protocol
Immediate Actions
- If experiencing severe reactions:
- Call emergency services (911)
- Contact the clinic immediately at [Clinic Emergency Number]
- Take photos of any visible reactions
- Note the time symptoms began
Common Emergency Situations
Allergic Reactions
-
Mild: Localized redness, swelling, or itching
-
Severe: Difficulty breathing, widespread hives, dizziness
Bleeding/Bruising
- Apply firm pressure with clean gauze
- Elevate the affected area
- Apply cold compress for 15-minute intervals
Infection Signs
- Increased redness or warmth
- Unusual swelling
- Fever
- Pus or discharge
Post-Procedure Care
24-Hour Support
- Clinic Emergency Line: [Number]
- After-hours Care: [Number]
- Online Portal: [Website]
Documentation
- Keep all post-procedure instructions
- Maintain a symptom diary if complications occur
- Take photos of any concerning changes
Follow-up Protocol
Scheduled Check-ins
- 24-hour phone check
- 1-week follow-up appointment
- Additional visits as needed
Keep this document readily available for 30 days post-procedure