Consent for Virtual Online Consultation
- I hereby consent to a Virtual Online Consultation with Dermology.
- 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.
- 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.
- 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.
- Hereby I confirm that all my details filled in the online form are correct.
Consent for In-clinic Consultation
- I hereby consent to a Consultation with Dermology in the practice.
- 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.
- Hereby I confirm that all my details filled in the online form are correct.