TAG REMOVAL AESTHETIC TREATMENT CONSENT FORM
Client Information
Full Name:
Date of Birth:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Address:
Phone Number:
Format: 00000000000.
Email:
example@example.com
Medical History
Please tick any that apply:
Medical History Options
Diabetes
Heart condition
Skin conditions (e.g., eczema, psoriasis)
Keloid scarring
Bleeding disorders
Back
Next
Allergies (please specify):
Other
Currently pregnant or breastfeeding
Taking medication (please specify):
Other
Other medical conditions:
Other
Treatment Information
I confirm that I am undergoing a tag removal procedure (including but not limited to skin tags, warts, milia, or similar lesions) using appropriate aesthetic techniques.
The procedure has been explained to me, including:
The nature and purpose of the treatment
Expected outcomes
Possible risks and side effects
Aftercare requirements
Back
Next
Risks & Side Effects
I understand that possible side effects may include:
Redness, swelling, or irritation
Minor bleeding or scabbing
Infection (rare)
Temporary or permanent pigmentation changes
Scarring (rare)
Client Consent
I confirm that:
I have provided accurate medical information
I have had the opportunity to ask questions
I understand the procedure and associated risks
I give my informed consent to proceed with the treatment
I understand that results may vary and no guarantee has been
made regarding outcomes.
Back
Next
Photography Consent (Optional)
I consent to before and after photographs being taken for records
I consent to photographs being used for marketing purposes
Client Signature:
Date:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Preview PDF
Submit
Should be Empty: