Laser Consent Form

It is important that you read this information carefully and completely.

Laser consent form.

My procedure i hereby give my consent for dr to perform a yag capsulotomy of the left right eye upon me. I understand the purpose of this treatment is to treat and possibly correct my diseased tooth and or tissues in my mouth. I understand the procedure is to be performed at the polyclinic. Download the laser hair removal consent form that is designed to assist a laser hair removal procedure it will address how the procedure works and explains possible risks and side effects.

Patient name date. Guardian name if applicable. Parent consent i acknowledge that the doctor has explained my child s condition and the proposed procedure. Fraxel treatment consent initial that you have read and understand this page.

It will also provide legally protective signatures needed for the establishment providing the procedure. Do not sign this form without reading and understanding its contents. If you have any questions please do not hesitate to ask some of the possible complications of nd yag laser treatment are. 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.

Fraxel dual is a non ablative fractionated laser. Yag laser capsulotomy consent form patient name. This has been recommended to. 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.

The nature of the fraxel restore dual procedure has been explained to me. Eye damage if baby or parent looks directly into the laser beam. Complete eye protection is available for all. This is an informed consent document which has been prepared to help inform you about laser treatment procedures of skin risks and alternative treatments.

I understand the risks of the procedure including the risks that are specific to my child and the likely outcomes. I have read and understand this consent form i agree to its terms and authorize treatment. 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.