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MoleMap New Zealand Patient Consent Form - molemap co 2026

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4.9 out of 5

59 votes

The MoleMap New Zealand Patient Consent Form is a document that collects personal and contact information from patients seeking skin assessments for melanoma detection. It outlines the types of consultations available, mandatory consent items regarding the assessment process, responsibilities of the patient, confidentiality of data, and conditions for follow-up appointments. The form also includes consent for the use of collected data for research purposes, ensuring that patients understand the limitations of the diagnosis related to specific lesions.

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Click ‘Get Form’ to open the MoleMap New Zealand Patient Consent Form in the editor.
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.
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.
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.
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.
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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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (59 Votes)

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How much does mole mapping cost?

Mole mapping is available from 315, which includes the facility fee and up to 5 complimentary dermoscopy images. As all patients require a consultant assessment, fees for this will be invoiced separately and range from 250 to 400, depending on the consultant.

What is the difference between a MoleMap and a mole check?

Unlike most skin checks, mole mapping is a complete surveillance programme that includes both total body photography and digital dermoscopy to detect the signs of melanoma and other skin cancers early essentially to nip skin cancer in the bud before it can spread and become life-threatening.

Does insurance pay for mole mapping?

Not all insurances cover mole mapping, but if yours does, and if your healthcare provider offers mole mapping, it may be a good option for you for early detection.

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