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Consent for Dermatology and Dermatological Surgery Mobile App

This Consent for Dermatology and Dermatological Surgery mobile app is designed to provide general descriptions of various dermatological treatments, including possible risks and benefits that may occur as a result of these treatments. Any dermatologic surgery requires informed consent about surgical procedures, risks of skin surgery, and information about the performing dermatologic surgeon.

All informed consent forms are securely stored in the GoCanvas Cloud. the information can be printed or emailed as a PDF if it needs to be sent to board-certified dermatologists, physician assistants, or to keep for your records. This app can be downloaded to an iPhone, iPad, or Android device.

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Take a peek inside the Consent for Dermatology and Dermatological Surgery Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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    Patient's Name

  • Ico textbox

    Date of Birth

  • Ico textbox

    Procedure to be performed

  • Ico statictext

    The following are some of the common procedures performed by a Dermatologist:

  • Ico statictext

    Skin biopsies and shave removal of skin lesions.

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    Curettage and dissection of tissue.

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    Incision and drainage of superficial abscesses.

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    Any other procedure as listed above.

  • Ico statictext

    Because these are considered minor surgical procedures, they have small risks associated with them.

  • Ico statictext

    The above statements have been discussed with me.

  • Ico statictext

    Do we have your permission to (please select):

  • Ico dropdown

    Leave a message with benign (normal) results on your answering machine at home?

  • Ico dropdown

    Leave a message with benign (normal) results at your place of employment?

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    Discuss your medical condition with any member of your household?

  • Ico signature

    (Patient or person authorized to give consent for the patient) Signature

  • Ico date

    Date

  • Ico signature

    Witness Signature

  • ...and More!

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