MoleMap New Zealand Patient Consent Form - molemap co 2026

1. Click ‘Get Form’ to open the MoleMap New Zealand Patient Consent Form in the editor.
2. Begin by filling in your contact details, including your title, first name, surname, date of birth, occupation, phone numbers, email address, and address. Ensure all fields are completed accurately for effective communication.
3. Next, provide the details of your nominated doctor who will receive a copy of your report. Fill in their name, address, suburb, postcode, and phone number.
4. Select the consultation type you are requesting today by checking the appropriate box. If unsure about which option to choose, consult with your Melanographer for guidance.
5. Review the mandatory items section carefully. You must understand and agree to each statement before signing. This ensures you are informed about the procedure and its implications.
6. Sign and date where indicated to provide consent for all subsequent MoleMap sessions. If applicable, complete additional consent sections regarding data use and specific lesion assessments.

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