SKIN TAG REMOVAL CONSENT FORM

PATIENT INFORMATION:

First Name

Last Name

Date Of Birth

Phone/Mobile

City

Next Of Kin

Kins Contact Number (Phone/Mobile)

MEDICAL HISTORY

Do you have a history of abnormal scarring, including keloids or hypertrophic scars?

Yes

If Yes, please specify:

Do you have any bleeding disorders or are you currently taking blood-thinning medications (e.g. anticoagulants)?

Yes

If Yes, please specify:

Do you have any active skin infections, irritation, or inflammation in the treatment area?

Yes

If Yes, please specify:

Have you been diagnosed with any medical conditions that affect healing (e.g., diabetes)?

Yes

If Yes, please specify:

Are you currently pregnant, trying to conceive, or breastfeeding?

Yes

If Yes, please specify:

Do you have any other medical conditions?

Yes

If Yes, please specify:

Procedure Description:

I understand that I am receiving a skin tag removal procedure, which is a minor cosmetic treatment used to safely remove benign skin growths (commonly known as skin tags).

The procedure may be performed using cauterization (heat) and the number of sessions can depend on the size, location, and characteristics of the skin tag.

During the procedure, the treatment area will be cleansed, and a local anesthetic or numbing agent may be applied to minimize discomfort. The skin tag is then carefully removed using the selected method, and the area may be treated to control bleeding and reduce the risk of infection.

I understand that the procedure is typically quick and performed in a clinical setting. After removal, a small wound may remain, which will gradually heal over time.

Healing time varies depending on the size and location of the skin tag, and proper aftercare is essential to ensure optimal healing and minimize complications.

Benefits and Risks:

I have been informed that the potential benefits of skin tag removal may include:

Safe and effective removal of unwanted skin tags
Improved cosmetic appearance of the skin
Reduction of irritation caused by friction from clothing or jewelry
Quick procedure with minimal downtime

I understand that there are potential risks and side effects associated with skin tag removal, including:

Mild discomfort during or after the procedure
Temporary redness, swelling, or tenderness in the treated area
Minor bleeding during or after removal
Formation of a small scab or crust as the area heals
Temporary or permanent changes in skin pigmentation

I understand that serious complications are uncommon but may occur in rare cases.

Aftercare:

I agree to follow the post-treatment instructions provided by the clinician to ensure the best possible results and minimize any risks. I understand that failure to adhere to these instructions may increase the likelihood of complications.

Consent for Treatment:

I hereby consent to undergo a Skin Tag Removal treatment. I acknowledge that the clinician has explained the procedure, its benefits, and potential risks to me. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction. I understand that the results of a Skin Tag Removal treatment can vary, and multiple sessions may be required for optimal results.

Release of Liability:

I release The Abram, its employees, and representatives from any liability associated with the Skin Tag Removal treatment, except for cases of negligence or intentional misconduct.

Human Error Acknowledgment:

I understand that aesthetic treatments are performed by qualified clinicians using professional equipment and established protocols. However, I acknowledge that, as with any procedure involving human involvement, there is a possibility of unintended outcomes due to human or technical error. By signing this consent, I accept this inherent possibility and agree that The Abram and its staff shall not be held liable for minor or unintentional errors occurring during the course of treatment, provided that reasonable care and professional standards are followed.

Photographs and records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

Client's Initial

Receptionist's Initial

Technician's Initial

I agree that all the above information is true and accurate to the best of my knowledge

Client’s signature: