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CLEAR + BRILLIANT INFORMED CONSENT

3525 Prytania Street, Suite 501 New Orleans, LA 70115 Phone: (504) 895-DERM (3376) CLEAR + BRILLIANT INFORMED CONSENT The nature of the CLEAR + BRILLIANT laser system procedure has been explained to me. I understand that just as there may be benefits from the procedure, all procedures involve risk to some degree. You will be treated with the CLEAR + BRILLIANT laser system. The CLEAR + BRILLIANT is FDA cleared for the following indications: Skin resurfacing Dermatologic procedures requiring photocoagulation EXPLAINATION OF PROCEDURE The treatments are spaced apart every 2-4 weeks for 4-6 treatments. Photographs will be taken at each visit. Please come with no make-up, including eyeliner, mascara, or lipsticks. The procedure itself takes 15 minutes to 45 minutes depending upon the size of treatment area.

CLEAR + BRILLIANT INFORMED CONSENT The nature of the CLEAR + BRILLIANT ™ laser system procedure has been explained to me. I understand that just as there may be benefits from the procedure, all procedures involve risk to some degree. You will be treated with the CLEAR + BRILLIANT ™ laser system. The CLEAR +

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