Botox Patient Forms

Botox Forms and Information 

 Please print and fill out all of the pages below that apply and bring with you to your appointment 

Pain Health History   ( All Patients)

Pre-treatment Dermal Fillers

Pre-Treatment Instructions


Informed Consent

Trigger point  (TMJ Patients)

Botox Treatment  (All Patients)


Informed Consent Dermal Fillers

Post Treatment Instructions 

151 Waterman St
Providence, 02906

Lena D. Karkalas, DDS

151 Waterman St

Tel: (401) 861-2140

MON - TUE : 7:00 am - 2:00 pm

WED : Closed

THU - FRI : 7:00 am - 2:00 pm

SAT - SUN : Closed

Patient Portal