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

Informed Consent Dermal Fillers

Informed Consent

Trigger point  (TMJ Patients)

Botox Treatment  (All Patients)

Pre-Treatment Instructions

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