INFORMED CONSENT FOR LASER THERAPY FOR VASCULAR TREATMENTS

PLEASE NOTE: FOR LASER TREATMENT
(a) Treatment of blood vessels (microvaricose veins and telangiectasias) is achieved using an Nd:YAG laser (λ=1064nm), through irradiation and therefore selective heating of blood vessels at a high temperature. This heating causes them to close (vascular sclerosis). Treatment may require multiple sessions, repeated over time, as the laser eliminates the effect, not the cause. For this reason:
- Multiple sessions are necessary to gradually achieve a good result (which, however, is not always permanent);
- The result of a single session may not be immediately visible and may take a few days;
- The result varies from person to person.
(b) How vascular treatment is performed. The laser is irradiated on the skin, applying gentle pressure with the device. During treatment (exposure times are short), a slight burning and/or stinging sensation (similar to a pinch, obviously more bothersome in more delicate areas and where the vessels are larger) is felt, directly proportional to the power selected for the treatment. This power can be reduced if necessary. The burning and/or stinging, however, rapidly diminishes, and any residual redness disappears one or more weeks after treatment.
The vessels in the treated area largely close during the procedure.
The treatment is safe because it is performed by qualified personnel and is generally well tolerated by everyone.
(c) Predictable results of laser-assisted vascular treatment: risks and complications. Among the various existing lasers, the most effective currently appear to be the Nd:YAG laser (λ = 1064 nm), universally recognized in the international literature. The thermal energy of the Nd:YAG laser (λ = 1064 nm) does not cause tissue damage because it is thermokinetically selective. However, even with these lasers, definitive resolution is only an expectation and cannot be 100% guaranteed (particularly for those with telangiectasia).
Anyone can undergo laser treatment, with the exception of those with certain skin conditions (for example, photodermatitis), pregnant women, those who have undergone surgery, those with pacemakers, metal plates, and/or implants, and those with tanned skin.
(d) Precautions to be taken before and after vascular treatment: the consequences of failure to observe the precautions.
Before treatment, it is advisable to shave the hair on the areas to be treated to prevent the laser beam from being absorbed only by the outer hair.
During treatment, everyone must wear special protective glasses.
For the first 24 hours following laser treatment, it is best to avoid bathing in very hot water to avoid traumatizing the treated area.
It is advisable to avoid exposing the treated area to the sun for three weeks, as complications may arise (such as, and as further specified verbally, scarring, hyper- or hypo-pigmentation of the treated skin, etc.).
SEM s.r.l. and its collaborators decline all responsibility if the patient fails to comply with the above precautions.
(e) Duration of treatment. A vascular laser treatment requires an average of one to six sessions.
(f) Any touch-ups performed on the treated area will be paid for by the client separately and at a lower cost than the cost of a single session.
IO SOTTOSCRITTO DICHIARO:

di non presentare alcuna delle controindicazioni al trattamento vascolare sopraindicate al § c. e che, comunque, mi è stata consigliata la visita di un medico al fine di escludere la sussistenza delle suddette controindicazioni;
having carried out this visit (in this second case assuming full responsibility for all risks I may encounter);
to have previously received a comprehensive verbal explanation regarding the type of treatment chosen, its alternatives, its consequences and/or risks and/or complications and/or temporary and/or permanent side effects, the frequency with which they may occur and any therapies I may need to undergo to treat any complications that may arise.
It is understood that the cost of any such therapies will be borne by me.

I have also reviewed the graphic renderings of the photos relating to this procedure in order to better discuss and agree on the purposes of the procedure and the achievable results. In this regard, I declare that I fully understand that the purpose of these graphic elaborations is purely informative and that what I have seen cannot in any way be considered as the final result that I will obtain, a result that could be, and likely will be, different from what has been represented to me graphically in the photograph.
As a consequence of the above, aware of both the expectations and the limits of the intervention, SEM s.r.l. and its collaborators to carry out:
intervention on microvarices and/or telangiectasias using the Nd:Yag laser (λ=1064nm);
subsequent interventions that may be necessary to complete the complete vascular treatment required;
any choice deemed necessary for my safety during the intervention, as well as any emergency procedures and/or therapies that may be necessary.
I consent to being photographed before, during and after the intervention, for the purpose of clinical documentation, which SEM s.r.l. undertakes to use only in a scientific context and with absolute confidentiality. guarantee of anonymity.
I release SEM s.r.l. and its collaborators from any liability relating to what is written.
GENERAL INFORMATION ON THE PROCESSING OF PERSONAL DATA
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.

IN FAITH

Clinica Milano – Skin Lab ®
I agree to be legally bound by this consent
and the Electronic Signature Terms of Use.