I understand the nature of the procedure/s.

I confirm that all risks and benefits of the procedure/s have been explained to me and are fully understood by myself.

I acknowledge that I have been advised of the risks of this procedure/s.

I am aware that the procedure/s is not an exact science and that the results cannot be guaranteed.

No such guarantee has been given to me as to the results of this procedure/s.

I consent that I do not suffer from any of the contraidications listed for this procedure/s.

I certify that I am at least 18 years old or I have parental consent co-signed below.

I agree that this constitutes full disclosure, and that it supercedes any previous verbal or written disclosures.

I certify that that I have read, and fully understand the information given to me, and that I have had sufficient opportunity for discussion and to ask questions.

I consent to this procedure/s today and for all subsequent treatments.