INFORMED CONSENT FOR FRACTIONAL LASER TREATMENT

Fractional laser treatment is indicated for the treatment of acne scars, stretch marks, melasma, chloasma, skin laxity, wrinkles, solar elastosis, post-surgical and post-traumatic scars, and post-traumatic hyperpigmentation. The treatment consists of multiple sessions performed over a period of several months, with gradual improvement of the condition over this period. After each session, diffuse redness and possibly crusting may appear, and in some cases, even diffuse swelling.

Subsequently, over the course of 1-3 weeks, the treated areas gradually improve. Clinical results and the number of treatments required may vary depending on the skin type and severity of the condition. Contraindications include: having a pacemaker, current or suspected pregnancy, use of medications that may increase photosensitivity (oral antidiabetics, tetracyclines, hydroxychloroquine, gold salts, phenothiazines), diabetes, kidney disease, vitiligo, and existing cancer. Another contraindication is exposure to the sun or artificial UV rays within 3 weeks of treatment.

Post-treatment side effects include redness, bruising, and swelling; more rarely, blisters and superficial burns, erythema, hyper- and hypopigmentation (patches lighter and/or darker than normal skin color), which may be permanent. Recurrence of herpes simplex may occur, even in a diffuse form. These effects were explained to me in detail by the doctor with whom I had preliminary consultations. I agree to undergo the medical and physical therapies prescribed in the period following treatment, being aware that failure to do so could compromise the outcome of the procedure.

I declare that I am aware that any exposure to the sun and/or artificial UV rays (tanning lamps) after treatment may increase the risk and severity of side effects. Since medicine is not an exact science, no guaranteed results can be guaranteed; the exact outcome cannot be precisely planned in advance. The percentage of improvement in the defect to be corrected, the extent, quality, and duration of side effects, and the symmetry of the result depend not only on the technique used, but also on the body's responses, which are strictly individual. For female patients, I declare that I am not pregnant.

I authorize the taking of photographic documentation, which will remain the property of the medical staff and will be used exclusively in my medical records, unless the Doctor deems its anonymous use (for publication in scientific journals or at medical conferences) to be useful for medical research and education. It will not be used for other purposes without my written permission. I acknowledge that the treatment is paid for and that I have been informed of the related cost. I certify that I have read and understood every point of this agreement, and that all my questions have been fully answered. I declare that I accept all the terms of this agreement.

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 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.