Dr. John Kippen
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Do you have or had any of the following? Anaesthetic problemsArthritisAsthmaBad scarsBleeding problemsBlood clotsCold soresDiabetesHealing problemsHeart problemsHepatitisHigh blood pressureHIV/AIDS riskPsychiatric treatmentSpinal/neck problems
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Declaration
I understand clinical photographs may be taken.
I give permission for clinical photographs to be used for medical education YesNo
I give permission for clinical photographs to be used for patient education YesNo
I give permission for these details to be used in communication with other health professionals involved with my care YesNo
I give permission for Dr Kippen to contact me via post or email YesNo
I have read the Patient Privacy Policy document YesNo
