Our service is available only to patients who reside in the UK during treatment. We are not able to take any other patients under care who live outside the UK, as it involves the prescription of medications under UK jurisdiction. If you aren't resident in the UK, we regret we won't be able to help you so please do not proceed with your booking. Thank you for considering TretDirect.
Isotretinoin Pregnancy Prevention Programme Acknowledgement Form
Isotretinoin can cause severe birth defects to an unborn baby if is it taken - even in small amounts - during pregnancy and there is an extremely high risk that you will have a severely deformed baby:
Do not sign this acknowledgement form and do not take Isotretinoin if there is anything that you do not understand about the information you have received about using Isotretinon.
The following points of information are clear to me:
I understand the risks and precautionary measures involved.
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, 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 TretDirect. I agree that TretDirect 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. 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.