AE Form for HCPs – Aesthetic MET

Patient Details

INITALS ONLY

Patient age / date of birth:

Current Medication (prescription or other)

Allergies (medicines or other) and reaction type.

Medical history (including surgery, dental, vaccinations or any other medical treatment)

Photos with patient consent

Maximum file size: 1.54MB

File Upload

Maximum file size: 1.54MB

Triage/Field Expert Comments

*The AMET nurse team will be notified via text message once this form is completed. We will respond via email within 24 hours; if in need of urgent assistance, contact AMA. AMET nurse email support service operates between AEST 8am-8pm Monday to Friday and 9am-5pm Saturday and Sunday.   If your request comes through outside business hours we will do our best to respond as soon as possible or within the next operating business hours. Please refer to adverse event protocols in the members only section on the AMET site able to be accessed 24/7. Please do not delay care to your patient and these times are a guide. AMET needs the contact information you provide  to contact you about the reported adverse event.  You may unsubscribe from these communications at anytime. For information on how to unsubscribe, as well as our privacy practices and commitment to protecting your privacy, check out our Privacy Policy. Please note reporting the adverse event does not replace reporting to  TGA, pharmaceutical companies or any legal obligation as a health care practitioner. Please do not delay care for your patient by completeing this form.  Reporting of an adverse event is only to be captured by the treating HCP and / or prescribing practitioner whom has treated and or presribed the medicine to the patient experiencing the adverse event or is actively managing the adverse event. By reporting the adverse event you are consenting and confirming the patient has given consent to report,  upload file and images of the adverse event to AMET  and AMET will only use for support, complication management and internal educational purposes. If you have an active adverse event please manage as per your protocols and if you require assistance please contact AMET via this online form.

If you are human, leave this field blank.

Adverse Event Form for HCP's

Healthcare professional details

Adverse Event Details

Patient Details