Consent Form for Procedures

Consent Form for Procedures(#9)

 

 

Consent and Risk Information


Surgical or Laser excision of Skin lesion/ Warts/ Moles/ Skin tags/ Cysts

THE FREQUENT OR SIGNIFICANT POSSIBLE RISKS INVOLVED INCLUDE: stinging, redness, swelling (expected) [less than 1 hour]; bruising (uncommon), headache, allergic reaction (very rare) [less than 2 days]; skin infection (uncommon) [1-2 weeks]; persistent numbness, fatigue (uncommon), scarring, altered pigmentation, altered sensation, and recurrence.

Other

I understand that the success of the treatment cannot be guaranteed and that more than one treatment session may be required for optimal results.

Consent of Patient or Person with Parental Responsibility

I confirm that the risks, benefits and alternatives of this procedure have been discussed with me, I understand what the treatment will involve and my questions have been answered to my satisfaction and understanding. I understand that photography is required and is an integral part of the procedure for personal medical records only. In line with the data protection act, your consent will be requested to use these for any other use.

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