Consent for Fractional CO2

Consent for Fractional CO2

Fill the form below after keenly going through the instructions.
*Initial

I duly authorize Dr, Elijah and her associates to use the Fractional CO2 laser system to perform ablative skin resurfacing and any post-treatment medical requirements that may be necessary.
*Initial

I understand that the Fractional CO2 laser is a laser device designed for ablative skin resurfacing and that clinical results may vary in different skin types. I understand there is a possibility of short-term effects such as reddening, blistering, scabbing, temporary bruising, and temporary discoloration of the skin.
I have read and fully understand the contents of this consent form.*

YesNo
With all of the above information understood, I am choosing to be treated with the Fractional CO2 laser.*

YesNo
By signing below, I verify that I have read and understand the above statements and agree to them.
Full Name*

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Date*

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