I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken.
I consent to the taking of photographs and authorize their anonymous use for the purposes of medical audit, education and promotion.
I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form.