PATIENT RIGHTS AND RESPONSIBILITIES

 We are committed to serving you with compassion, care, and respect. As one of our valued clients, you are entitled to the following:  

You have the right:

  • To be treated with respect and dignity.
  • To know the name and professional status of the person(s) serving you.
  • To privacy and confidentiality.
  • To receive accurate information about your health-related concerns.
  • To know the effectiveness and potential side-effects of all forms of treatment.
  • To participate in choosing the form of treatment best suited to your skin.
  • To receive education and counseling about treatment.
  • To review your medical record with your clinician.
  • To amend your records.
  • To receive any information about potential services or related services

You have the responsibility:

  • To seek medical attention promptly, and to provide useful feedback.
  • To be honest about your medical and social history.
  • To be honest about your lifestyle risks and exposures.
  • To ask questions about anything you do not understand.
  • To follow health advice and instructions.
  • To report any significant changes in your health.
  • To respect clinic policies.
  • To show up for appointments or cancel 48 hours in advance.


 By signing this form, I certify: 

  • I have read this form or had this form explained or read to me in its entirety.
  • I have read or had the Consents for Treatment explained or read to me in their entirety. I understand its contents, including the risks and benefits of treatment, telemedicine, email use, voicemail/text appointment reminders, and all other topics therein.
  • I give my consent for treatment and accept all associated risks.
  • I have read or had 1988’s Financial Policy explained or read to me in its entirety. I understand its contents and agree with and accept the terms and requirements.
  • I have read or had 1988’s Privacy Policy / HIPAA Notice of Privacy Practices explained or read to me in its entirety. I understand its contents and agree with and accept the terms and requirements.
  • I have read or had the Patient’s Rights and Responsibilities explained or read to me in its entirety. I understand its contents and agree with and accept the terms and requirements.
  • I have had the opportunity to ask questions regarding all contents herein and the treatment(s) to be provided by 1988, and have had them answered to my satisfaction.