Consent for Virtual Online Consultation

  1. I  hereby consent to a Virtual Online Consultation with Dermology. 
  2. I agree for the consultation to be recorded and kept in my personal record file online, should we ever need to refer back to it. 
  3. I am aware that the consultation and all information shared with Dermology is confidential and will not be shared with anyone unless approved by either party in writing.
  4. I also understand that the consultation will accompany a full prescription in terms of products recommended to me, a treatment plan and a maintenance plan. I will also be able to follow up with my therapist through any of Dermology’s contact lines.
  5. Hereby I confirm that all my details filled in the online form are correct.

 

Consent for In-clinic Consultation

  1. I hereby consent to a Consultation with Dermology in the practice. 
  2. I understand the consultation will accompany a full prescription in terms of products recommended to me, a treatment plan and a maintenance plan. I will also be able to follow up with my therapist through any of Dermology’s contact lines.
  3. Hereby I confirm that all my details filled in the online form are correct.