GENERAL CONSENT TO TREAT
I authorize Portrait Health managed entities* to evaluate, examine and/or diagnose me for purposes of identifying and recommending aesthetic dermatology services and treatments. I understand that if I choose to proceed with a recommended treatment plan, I will be asked to provide informed consent with respect to the specific service(s) and/or treatment(s) I choose to obtain.
I understand and agree that:
- This consent is continuing in nature, even after a specific diagnosis has been made and treatment options recommended.
- This consent will remain fully effective until I revoke it in writing.
- I have the right to ask questions at any time or discontinue or decline services.
- I have the right to discuss any proposed treatment plans with my provider, including potential risks, complications, benefits and alternatives of any treatment recommended.
- I understand that I am financially responsible for any service(s) and/or treatment(s) I receive and that my insurance will not be billed.
- I understand that Portrait managed entity providers are in addition to, and not a replacement for, my primary care provider. Responsibility for your overall medical care should remain with your primary care provider, if you have one, and we strongly encourage you to locate one if you do not.
- I have read and fully understand the above statements and consent fully to its contents.
* Portrait Health Inc. and its managed medical practices, including DermDocs, PC, Portrait Health Care, PLLC and Portrait Health Care New Jersey, PC, work closely with nurse and physician assistants to provide services to shared patients. This includes providing nurse and physician assistant-led entities with a wide range of administrative and clinical support services in accordance with medspa industry standards, and applicable laws and regulations.