Patient Information Confirmation and Risk Acknowledgment Form

At Garden of Eden we are committed to maintaining the highest standards of patient care and safety. To ensure that your treatment remains appropriate and safe, we ask all patients to review and complete this form prior to each appointment. 

Section 1 - Personal and Medical Information Confirmation 

I confirm that there have been no changes to my personal information, medical history, medications, supplements, allergies, or health conditions since my last visit. I understand that accurate medical and personal information is essential for the safety and effectiveness of my treatment. If any changes have occurred, including new diagnoses, recent surgeries, changes in medication, or other health concerns, I agree to inform the clinic staff before receiving any procedure today so that my file can be updated. 

Section 2 - Consent and Understanding of Risks 

I acknowledge that I have previously reviewed and signed all relevant consent forms related to my treatment(s) at this clinic. These documents have outlined the purpose, expected benefits, potential risks, and possible side effects associated with the procedures I receive. I confirm that I have had the opportunity to discuss these details with my practitioner, and that all of my questions or concerns have been addressed. I understand that no treatment or procedure is entirely risk-free, and that individual results may vary depending on factors such as my skin type, age, health condition, and adherence to post-treatment care instructions. I also understand that while complications are rare, they may include temporary or lasting side effects such as redness, swelling, bruising, pigmentation changes, sensitivity, or other unanticipated reactions. My provider has explained these possibilities to me, and I acknowledge and accept them as part of the informed consent process. 

Section 3 - Ongoing Consent and Responsibility 

I understand that my previously signed treatment consents remain valid and in effect unless updated or withdrawn in writing. By signing below, I acknowledge that I wish to proceed with my scheduled treatment(s) under these same terms and conditions. I confirm that I am voluntarily choosing to receive treatment today, and that I accept full responsibility for this decision and any potential outcomes associated with the procedure(s) performed. I understand that the clinic staff and practitioners will perform all treatments in accordance with professional standards and safety protocols. I have been advised that I may stop treatment at any time, request additional information, or withdraw consent should I choose to do so. 

Section 4 - Confirmation 

By signing this document,I acknowledge that I have read and understood the above statements, that the information I have provided is complete and accurate, and that I agree to proceed with treatment under the same terms of consent as previously signed.