New Patient Registration

I agree to allow Ethique Plastic Surgery access to all relevant information regarding my medical conditions. I understand that they may be required to forward information about my medical condition or history to other health care providers. I understand that to provide the highest medical care, my clinical records may be accessed or reviewed by staff in this practice.

I agree that clinical photographs may be taken by Ethique Plastic Surgery as part of my consultation to be kept with my confidential medical records within this Practice.

I agree that my unidentifiable clinical photographs may be used for research, medical education or public education purposes.