Consent Statement for Obagi Medical ProductsConsent Confirmation
To help us assess that we have listened to, and responded to, your concerns and preferences and have given you sufficient information in the way that you want and can understand it would be helpful to confirm the following statements:
I can confirm that I understand the treatment proposed and any relevant alternatives and I am willing to proceed.
I have had sufficient time to appreciate the risks involved and in particular I can confirm the clinical team/clinician has worked with me to understand and discuss those risks to which I would attach particular significance.
I am of the opinion that my request for treatment is for medical reasons and/or the personal psychological features that are associated with my request. I have expressed my thoughts and feelings to the treating doctor and consent to the treatment for the purpose of restoring and maintaining my health and psychological wellbeing.
I have read this in conjunction with the information provided and I have had the potential risks and side effects associated with my treatment fully explained to me.
I acknowledge and understand that no guarantee or assurance can be made on the results I will get from the treatment.
I consent to the taking of photographs in the course of this procedure for the purpose of assessing my progress.
I am satisfied that I have sufficient knowledge of the treatment to give informed consent.
Patient has confirmed via E-Signature:
I confirm that I have discussed the treatment plan with the above patient and undertake treatment with the purpose of restoring or maintaining health, including the psychological wellbeing of my patient. I also confirm that I accept duty of care for my patient and the standard of care as set out by the GMC in Good Medical Practice/NMC/IMC/IDC/NMBI Guidelines. In doing so, I recognise my primary purpose and undertaking is to place the health and wellness of my patient as my first concern.