Tretinoin Consent 0.25%, 0.1%, .05% Gel and Cream, and Refissa .05%Tretinoin must be used in the prescribed fashion according to the written instructions and descriptions given to me. I understand that I will experience varying degrees of the following symptoms: Dryness - Redness - Exfoliation/Peeling - Itching - Sensitive Skin - Burning - Wrinkles May Look Worse - Acne May Look WorseInitial*These symptoms will lessen and eventually subside as my skin builds tolerance. I agree to continue with the use of Tretinoin and to return for follow-ups as directed. Doing so will help with my safety and provide adjustments towards maximizing results.Initial*I understand the best results are achieved with adherence to the program over several weeks and/or months.Initial*I understand that excessive application of the products or picking, rubbing the skin can cause a great deal of discomfort and even blistering, especially in the early weeks of treatment. If any reactions are initiated to the point of skin breakdown or infection, I will contact the office immediately. Careless inattention to such reactions may result in complications such as infection, injury, discoloration, or possible superficial scarring.Initial*I understand that it is necessary to maintain the use of my prescribed protocol throughout the treatment period. This is necessary to retain the benefits during the program.Initial*If you are pregnant, think you are pregnant, or are nursing an infant:No studies have been conducted in humans to establish the safety of Tretinoin in pregnant women. If you are pregnant, think you’re pregnant, or are nursing a baby, consult your physician before using the medication. It is not recommended that you use Tretinoin if you are pregnant, think you are pregnant, or are nursing an infant. Initial*I understand a sunscreen of at least SPF 50 is to be used on a daily basis, and to practice sun safe guidelines when outdoors.Initial*I understand that I must adhere to the guidelines prescribed.Initial*Consent* I have read and fully understand the above, received satisfactory answers to my questions and had a chance to discuss alternative treatments.Patient's Name* First Last Email Address* Phone*Date* Date Format: MM slash DD slash YYYY Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.