Laser Consent Form
If you are interested in getting Laser treatment, please fill out and submit this consent form, skin type form, and medical history form. All of these forms are located at the "Forms" tab on the website. (g2jclinic.com) Filling out and submitting all these forms before coming to the office will waive the $250 consultation fee.

G2J Clinic Inc,
5150 Graves Ave. San Jose, CA 95129
408-253-8000
g2jclinic.com

Name *
Your answer
Date of Birth *
Your answer
Email or Phone Number *
Your answer
Please mark the checkboxes as you read the form to show you have understood each sentence
If you have any questions, please ask the doctor during the office visit for any clarifications.
ProFractional Therapy *
Required
Review of facts about light therapy *
Required
Pre-treatment considerations *
Required
Treatment considerations *
Required
Common side effects and risks *
Required
I have read and understand all information presented to me before signing this consent form. I understand the procedure and accept the risks. I agree to the terms of this agreement. *
Please write your name and date down below to serve as a signature. You will be asked to write your signature at the office again to verify.
Your answer
Submit
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