By signing below, I am consenting to allow Bright Eyes Recovery and Wellness LLC. and their licensed nurse to assess my wound and provide wound care via aseptic technique and/ or as per surgeon/physician orders and plan of care. I have had the opportunity to ask any questions that I might have regarding wound care; the reasons the procedure is being performed; the potential benefits; the associated potential risks and complications; and the possible alternative forms of treatment.
I agree to undergo the procedure, to be performed by Bright Eyes Recovery and Wellness LLC. Name, their associates, assistants, and appropriate personnel, and accept the risks.
I understand that during my wound care, photographs of my wound and the surrounding area may be taken. These photographs will be used for treatment purposes including the assessment and evaluation of my wound
Additionally, by signing below, I agree to forever hold harmless and release Business Name from any and all liability, claims, or demands of any kind or nature related this procedure and/or to the transmission of any disease, condition or illness I may allege to have contracted or been exposed to as the result of any treatment, person, or visit performed by Bright Eyes Recovery and Wellness LLC. whether in clinic, in my home, or any other mobile location.