Ultra Clear Laser Consent

Ultra clear laser

Ultraclear Laser Consent

______________________ has explained to me that I am a good candidate for UltraClear™ Fractional Laser Resurfacing treatment and that although laser procedures have been shown to be highly effective, no guarantees can be made.(Required)
Patients/Guardians Signature(Required)
MM slash DD slash YYYY
Witness' signature(Required)