Consent for Treatment
I confirm that the Specialist has given me sufficient information to enable me to understand the treatment in accordance with the approved indication. I have received information regarding the treatment’s contra-indications and potential undesirable effects. I have also been given the opportunity to ask all questions I have regarding the treatment and I have received additional explanation to my satisfaction. When completing the medical history, I have answered the questions fully and to the best of my ability.
I understand that Isotretinoin treatment can have serious side effects (e.g. inflammatory bowel disease, may affect libido, may cause long term dry eyes), which have been explained to me. I understand that, once I embark on a course of treatment, I am committed to completing the treatment unless discharged earlier for medical reasons. I understand that prescriptions must be presented for filling at a pharmacy within 7 days of issue, otherwise they may be rejected and a replacement prescription will be chargeable.
I confirm that I agree to my photographs being stored as required for diagnostic purposes and to enhance the medical records. I agree that these photographs will remain property of TreatDirect. I agree that TreatDirect may use these discreetly for medical, scientific or other publications and presentations, marketing and website information with due respect to my client confidentiality.
I have been fully informed of the risks and possible consequences involved in the treatment being sought. I understand that no warranty or guarantee has been made to me as to result or cure. It is possible that the result might not live up to the expectations or goals established. In this connection I am aware that the practice of cosmetic dermatology is not an exact science and that therefore reputable specialists cannot guarantee results. Once a patient is taken under care, payment plans must be paid in full even if the patient abandons treatment for any reason. I understand that there are NO REFUNDS. I hereby authorise the Specialist to administer such treatment to me and agree to hold them free and harmless from any claims or suits for damage for any injury or complications whatever that may result from this treatment.