Laser Consent - The Aesthetic Chapter Singapore

Name *

First

Last

Full IC Number / FIN *

Todays Date

Authorization

I hereby authorize the MOH registered doctor to remove or lighten the appearance of vascular lesions/ pigmentation or to remove benign lesions. I understand it may take multiple treatments to obtain optimal results. Although these devices are effective in most cases, no guarantees can be made. I understand I may not experience complete clearance. Some conditions may not respond at all and, in rare cases, may become worse.

I acknowledge the following points have been discussed with me:

Potential benefits of the proposed procedure, including the possibility that the procedure may not work for me
Possible complications/risks involved with the proposed procedure and subsequent healing period
Other options are explained to me
or women of childbearing age: I confirm that I am not pregnant and do not intend to become pregnant anytime during the course of treatment. Furthermore, I agree to keep Dr and staff informed should I become pregnant during the course of treatment. Photographic documentation will be taken for record and for teaching purposes.

ACKNOWLEDGMENT

BY MY SUBMISSION BELOW, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS INFORMED CONSENT FOR THE USE OF LASERS, AND THAT I HAVE HAD ALL MY QUESTIONS ANSWERED TO MY SATISFACTION BY MY HEALTHCARE TEAM.

Consent For Laser Treatment