COVID Consent

[Please read the information below before coming to the clinic – we will ask you to sign a digital copy at your appointment]

Important Background to the Consent Process

Your clinician wishes to help you make an informed decision about your treatment options and any relevant alternative options. You may at any time decline treatment, even after giving your consent.

Whilst your clinician will make every effort to understand what significance you would attach to any particular risk it is important to us that you feel comfortable enough to question the clinician on any point of concern during this process. Please feel you have as much time as you wish to reflect on the information given before agreeing to proceed with the treatment.

Purpose of this document

You have presented with concerns which have formed the basis of a clinical discussion and examination. The purpose of the proposed treatment is to address your concerns either individually or in combination with other modalities of treatment.

This consent addresses an additional risk involved when performing your treatment at this moment as we cannot keep safe social distancing when treating you. Some treatments present a higher degree of risk than others, either because of the site (close to the nose or mouth) or because their treatment may generate aerosol, splash or plume.

We have risk assessed and determined which treatments require specific and additional measures and which treatments cannot be offered at this moment. We have considered also the concerns that patients and staff might have and ensure measures satisfy their need to feel safe.

Outcomes

Your clinician will endeavour in good faith to employ the principles of best practice in delivering your treatment. Each patient is individual and response to treatment will vary from patient to patient and treatment to treatment. As such it is difficult to guarantee outcomes will always meet your expectations.
Please make your clinician fully aware of your expectations prior to giving consent. If you have any worries or concerns regarding COVID please let us know before attending the clinic.
Subject to patient and treatment specific risk assessment, we aim to plan procedures to minimise contact time. Multiple procedures in one session should be avoided as per government and professional organisations advice already in place. This may change in the future.

Vaccinations

Updates about skin reactions, that may or may not be COVID-19 vaccination-related, are coming in thick and fast from our medical colleagues.

These reactions centre around skin inflammation, but are not limited to this, so other unexpected reactions could occur.

To minimise any reactions, please read the current advice outlined below which may affect your next treatment with us and rearrange your appointment with us if necessary.

Please do not re-arrange your vaccination appointment – this must be a priority.

Dermal Filler Treatment
You should not have treatment 2 weeks before and up to 3 weeks after your vaccination.

All other treatments
You should not have treatments until at least 2 weeks after your vaccination. You can continue to have your treatment up to the date of your vaccination.

Consultations
You can continue to have your consultation at any time provided you feel well enough.

Increased risk individuals

Please let us know if you:

• Have been sent a shielding letter from the NHS: if you suffer from any of the following system diseases such as cardiac disease; respiratory disease; liver disease; kidney disease; Diabetes; Immunodeficiency; Currently being treated for cancer; Obesity; Age 65 or over.
• Live with vulnerable family members (elderly or shielding).
• Have had recent contact (within 14 days) with someone diagnosed with Covid-19.
• You are currently employed and there are not effective/ possible social distancing measures at work.
• Live with family who continue to work without adequate/ possible social distancing.
• Use public transport to work.
• Have recently travelled by air.
• If you suffer from any seasonal allergies which cause spontaneous coughing or sneezing.
• We know that ethnicity (black and asian) seem to increase the risk of severe disease. Please do not be offended if we discuss any of the above in more detail with a view to postpone your treatment until government advice regarding risk reduction changes.

Patient COVID consent statement

I confirm that I am not presenting with any of the following symptoms of COVOID-19 listed below:

• Fever
• Lethargy, tiredness, no energy, feeling wiped out
• Shortness of breath
• Loss of sense of taste or smell
• Cough: dry or productive (with phlegm)
• Chest aching/discomfort when breathing or coughing
• Runny nose, congestion, pressure sensation (similar to sinusitis)
• Sore throat
• Headache
• Nausea, diarrhoea, abdominal pains
• Muscle aches and pains in back and/or limbs
• Rash

I understand that I am opting for an elective medical treatment/procedure/surgery, which carries an additional risk as it is performed during the pandemic. In infected patients a viral load is present in the nose and throat.

Consent Confirmation

To help us assess that we have listened to, and responded to, your concerns and preferences and have given you sufficient information in the way that you want and can understand it would be helpful to confirm the following statements:

1. I can confirm that I understand the treatment proposed and any relevant alternatives and I am willing to proceed.
2. I have had sufficient time to appreciate the risks involved and in particular I can confirm the clinical team/clinician has worked with me to understand and discuss those risks to which I would attach particular significance. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective medical treatment /procedure /surgery, and I give my express permission to proceed.
3. I am of the opinion that my request for treatment is for medical reasons and/or the personal psychological features that are associated with my request. I have expressed my thoughts and feelings to the treating doctor and consent to the treatment for the purpose of restoring and maintaining the health and my psychological wellbeing.
4. I understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and as a result, social distancing is recommended. This is not entirely possible with my proposed treatment however I am satisfied that safety measures are in place to minimise risk as much as possible, and patient contact will be kept to an absolute minimum in line with medical need.
5. I understand the Management and Clinical Staff are closely monitoring the COVID-19 situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with treatment.
6. I understand the COVID-19 virus can have a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious.
7. I have read this in conjunction with the information provided about the treatment(s) proposed, and I have had the potential risks and side effects associated with my treatment fully explained to me.
8. I understand that COVID-19 can cause additional health risks, some of which may not currently be known, in addition to those risks associated with the medical treatment/ procedure/ surgery itself.
9. I acknowledge and understand that no guarantee or assurance can be made on the results I will get from the treatment.
10. I have been given the option to defer my medical treatment/procedure/surgery to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired medical treatment/procedure/surgery.
11. I understand that the risks described above significantly increase my risk of contracting and transmitting the COVID-19 virus. I confirm that I have not travelled in the past 14 days.
12. I confirm that if I develop COVID-19 symptoms following my medical treatment/ procedure/ surgery, or a known contact of mine develops symptoms, I will immediately inform the Clinic to enable appropriate measures to be put in place and contact tracing to commence.
13. I am satisfied that I have sufficient knowledge of the treatment to give informed consent.

[We will ask you to confirm via E-Signature at your appointment]

I confirm that I have discussed the treatment plan with the above patient and undertake treatment with the purpose of restoring or maintaining health, including the psychological wellbeing of my patient. I also confirm that I accept duty of care for my patient and the standard of care as set out by the GMC in Good Medical Practice/NMC Guidelines. In doing so, I recognise my primary purpose and undertaking is to place the health and wellness of my patient as my first concern.

[Your clinician will confirm via via E-Signature at your appointment]