SKIN TAG, MOLE & SPOT REMOVAL INFORMED CONSENT

The purpose of this informed consent form is to provide written information regarding the risks, benefits and alternatives of the procedure named above. This material serves as a supplement to the discussion you have with your doctor/healthcare provider. It is important that you fully understand this information, so please read this document thoroughly. If you have any questions regarding the procedure, ask your doctor/healthcare professional prior to signing the consent form.

A pen emitting an arch of energy is used to burn off the skin tag, mole or dark spot. The skin will create a scab which remains on the skin for 1-2 weeks until the skin has healed. There might be slight discoloration of the skin after the scab falls off. This will take a few weeks to a few months to fully heal to your normal skin tone depending on health, age and skin tone factors. If there is any regrowth post procedure in the same spot within the following few months, you MUST come in a get it removed again. Initials:

Please note: No medical provider can guarantee a "scarless" procedure. The procedure will be performed in a way meant to minimize the visibility of scarring. The scar will initially be red and raised but usually reduces in color and size over several months. The healing process can take between 3 months to 1 year. Some people have an abnormal response to skin healing and these people may get larger scars than usual (keloid or hypertrophic scarring If the area becomes reddened, very painful or drainage is present, please call your Service Provider as it could be infected. Failure to comply with post-care instructions may result in undesired and unpredictable  results. Initials:

I understand that this is an "elective" procedure and that payment is my responsibility and is expected at the time of treatment. Initials:

I give permission to take before and after photographs of my treatment to be used to monitor my treatment, training purposes, and advertising. Initials:

I understand that I have the right to discontinue treatment at any time. Initials: I understand this is an elective procedure and I hereby voluntarily consent to treatment of skin tag, mole, and spot removal. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the Service provider who is treating me and I will direct all post-operative questions or concerns to the treating clinician. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the doctor/healthcare professional who treated me immediately. I also state that I read and write in English.