Consent Form for Areola Pigmentation - - A Nu Yu 2025

1. Click ‘Get Form’ to open the Consent Form for Areola Pigmentation in our editor.
2. Begin by filling in your personal information, including your Name, Address, City, State, Zip Code, Home Phone, Work Phone, and Date of Birth. Ensure all details are accurate for effective communication.
3. Next, provide information about your Medical Physician and Plastic Surgeon. This section is crucial for ensuring your safety during the procedure.
4. List any Allergies and known Medical Conditions. Be thorough to help the practitioner understand your health background.
5. Indicate if you are allergic to Lidocaine or Vitamin E and whether you are a Hemophiliac. This information is vital for your treatment plan.
6. In case of an emergency, provide the contact details of someone who should be notified.
7. Review the Photograph Release section and initial where indicated to grant permission for before and after photos.
8. Read through the After Care Instructions carefully and initial each statement to confirm your understanding of the procedure's implications.
9. Finally, sign and date the form at the bottom to complete your consent. Make sure you have a copy for your records.

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