Laser Consent Form

Acknowledgement of consent for laser treatment this authorization and informed consent is given of my own free will after the doctor has explained to me the foreseeable dental and medical risks involved and discussed below.

Laser consent form.

Parent consent i acknowledge that the doctor has explained my child s condition and the proposed procedure. Patient name date. This has been recommended to. My procedure i hereby give my consent for dr to perform a yag capsulotomy of the left right eye upon me.

Complete eye protection is available for all. It will also provide legally protective signatures needed for the establishment providing the procedure. The nature of the fraxel restore dual procedure has been explained to me. Guardian name if applicable.

Do not sign this form without reading and understanding its contents. I have read and understand this consent form i agree to its terms and authorize treatment. Gene greenlees md or wendy greenlees rn np has explained the nature and purpose of the laser treatment including any risks and possible complications and has discussed the contents of this form with me. Click here to download patient forms for laser hair removal consent.

This form is designed to give you the information you need to make an informed choice of whether or not to undergo nd yag laser treatment. If you have any questions please do not hesitate to ask some of the possible complications of nd yag laser treatment are. I understand the procedure is to be performed at the polyclinic. It is important that you read this information carefully and completely.

Fraxel dual is a non ablative fractionated laser. I understand the risks of the procedure including the risks that are specific to my child and the likely outcomes. Laser assisted cataract surgery is an addendum to our main cataract consent form ask patients to sign this form if you use the femtosecond laser for some of the steps of cataract surgery or if you use it to perform a relaxing or arcuate incision to treat astigmatism. I do hereby waive release absolve.

Fraxel treatment consent initial that you have read and understand this page. Eye damage if baby or parent looks directly into the laser beam. This is an informed consent document which has been prepared to help inform you about laser treatment procedures of skin risks and alternative treatments.