INFORMED CONSENT FOR CLEAR LIFT AND CLEAR SKIN TREATMENTS

The non-ablative fractional treatment stimulates new collagen without damaging the treated skin through a grid of tiny, pinpoint holes that penetrate deep into the dermis.

The treatment targets only a fraction of the entire surface (hence the name fractional) each time, and the method requires multiple sessions for optimal results. The number of sessions varies from 2 to 6 or more, depending on the type and extent of the problem being treated. During the treatment, a slight warmth is felt, and slight redness may occur, which will disappear within an hour.

The improvement is gradual and may be more or less noticeable after each session, depending on the patient's response. As a result of the skin renewal process, increases or decreases in color (hyper- or hypo-pigmentation) may occur, which are usually temporary and rarely permanent. Only in cases of abnormal skin reactivity may scarring occur. I declare that I am not pregnant and am not taking any photosensitizing medications and/or drugs.

In the days following treatment, it is necessary to follow the doctor's instructions and avoid exposing the treated areas to the sun for 24 hours. I understand that, given the individual variability of response to any medical-surgical treatment, there can be no certainty of results, nor can the percentage of improvement be precisely predicted. I have been informed that by not undergoing the treatment, I would not expose myself to any risk, and I have been explained the significant alternatives to treatment.

I authorize the collection of photographic documentation, which will remain the property of the healthcare professional for clinical archiving purposes. This documentation may be used anonymously for the purposes of research, education, or medical dissemination. I agree to undergo the therapies and check-ups prescribed in the period following the treatment, having been informed that failure to do so could compromise the outcome of the procedure. I declare that I am aware that the treatment is paid for and that I have been informed of the related cost.

I certify that I have been informed by the specialist about the nature of my dermatological problem, and that I have discussed the characteristics and indications of the treatment I received, including its probable benefits, risks, and complications. After receiving all the explanations I requested, I agree to undergo the above-mentioned treatment, expressing my consent on this form, which I have read and adequately understood in advance.

With reference to the images (photos and videos) taken and/or filmed by the Clinica Milano – Skin Lab ® , essential for drawing up your treatment plan and for managing diagnoses and future assessments, you hereby AUTHORIZE, free of charge, without time limits, also pursuant to articles 10 and 320 of the Italian Civil Code and articles 96 and 97 of Law 22.4.1941, n. 633, Copyright Law, to the storage in the medical records and possible publication and/or diffusion in any form of your images on the website, Facebook page and/or Instagram profile of the Company/Entity/Private individual, as well as on printed paper and/or on any other means of diffusion, as well as authorizing the conservation of the photos and videos themselves in the computer archives of the Clinica Milano – Skin Lab ® and acknowledges that the purpose of such publications is merely for informational and possibly promotional purposes. This release/authorization may be revoked at any time by written notice sent by registered mail or certified email.

Pursuant to and for the purposes of GDPR 2016/679 and Legislative Decree 101/18, regarding the protection of personal and sensitive data, I consent to the doctor acquiring my personal and clinical information in paper and/or electronic form in the form of written notes, images, and video documentation of me before, during, and after treatment. I understand the doctor's need to document his or her actions in order to have objective feedback on the pre- and post-treatment situation, even over time.

Pursuant to Articles 13 and 14 of EU Regulation No. 2016/679 (the "Regulation") and the provisions of Legislative Decree No. 101/18 (the "Legislative Decree") concerning the protection of natural persons with regard to the processing of personal data, I hereby inform you that the personal data you provide and acquired by Clinica Milano – Skin Lab ® will be processed in compliance with the provisions of the aforementioned Regulation and Legislative Decree. Furthermore, the following is specified:

1. Purpose of processing

The processing of your personal data is solely for the proper performance of aesthetic medicine, prevention, diagnosis, treatment, rehabilitation, or other pharmaceutical and/or specialist services requested by you.

2. Methods of Processing Personal Data

Processing is carried out through operations performed on paper or with the aid of IT tools, or via apps and cloud platforms, and consists of the collection, recording, organization, storage, consultation, processing, modification, selection, extraction, comparison, use, interconnection, blocking, communication, deletion, and destruction of such data. Sometimes, it may be necessary to send data electronically via email, which will be encrypted and password-protected. Processing is carried out by the data controller and by persons expressly authorized by the data controller.

3. Provision of Data and Refusal

The provision of general, sensitive, genetic, and health-related personal data is necessary for the performance of the activities required for prevention, diagnosis, treatment, rehabilitation, or other pharmaceutical and/or specialist services requested by you. Your refusal to provide personal data will make it impossible to perform these activities.

4. Data Disclosure

The personal data collected will not be disclosed. The data will not be shared with third parties, except when necessary and/or required by law and/or for tax compliance. The data will be disclosed only to healthcare personnel at the facility where Clinica Milano – Skin Lab® operates and, where necessary, to physicians, analysis laboratories, medical specialists, hospitals, and consultants—lawyers and/or accountants—used by Clinica Milano – Skin Lab®.


5. Data Retention

Your personal data will be retained for the time strictly necessary for medical care and, in any case, for no longer than ten years. Even when computers are used, appropriate protection measures are adopted to ensure the correct storage and use of data, including by medical practice staff, in compliance with professional secrecy. Professionals and facilities that may have access to such data as a result of the healthcare services provided by Clinica Milano – Skin Lab ® are also required to observe these safeguards.

6. Data Controller

The data controller is Clinica Milano – Skin Lab ®, Via Cerva, 22 – 20122 Milan – SEM s.r.l. | VAT No. 11055590969

7. Rights of the Data Subject

The data subject has the right:

• to request from the data controller access to, rectification or erasure of, or restriction of processing of, personal data, or to object to processing, as well as the right to data portability;
• to receive, in a structured, commonly used, and machine-readable format, the personal data concerning him or her, which he or she has provided to a data controller, and has the right to transmit those data to another data controller without hindrance from the data controller to which the personal data have been provided;
• to withdraw consent at any time, without affecting the lawfulness of processing based on consent before its withdrawal;
• to lodge a complaint with the Italian Data Protection Authority.

The aforementioned rights may be exercised by written communication sent via certified email to semsrl1@pec.it or by registered mail with return receipt to Via Cerva, 22 – 20122 Milan.

With reference to the images (photos and/or videos) taken and/or filmed by Clinica Milano – Skin Lab ®, which are essential for developing your treatment plan and managing diagnoses and future assessments, you authorize, free of charge and without time limits, also pursuant to Article 10 of the Italian Civil Code and Articles 96 and 97 of Law No. 633 of April 22, 1941 (Copyright Law), the storage in your medical records in paper format or with the aid of IT tools or via apps and platforms that use the Cloud, and the possible publication and/or dissemination of your images in any form on the Clinica Milano – Skin Lab ® website or on its social media profiles such as Instagram or Facebook. I also authorize the storage of these photos and videos in the electronic archives of Clinica Milano – Skin Lab®, confirming that the purpose of such publications is purely for informational and educational purposes regarding the professional activities carried out by Clinica Milano – Skin Lab®. This authorization may be revoked at any time by written notice sent by registered mail or certified email.

The undersigned declares that he or she has read the above information, accepts all of its provisions, and consents to the processing of his or her personal data for the purposes, terms, and conditions set forth above.