Wart Removal Consent Form printable pdf download

Wart Removal Consent

Name:_________________________________

Date:

1. How long have you had warts? Weeks / Months / Years

2. Have they recently worsened? Yes / no

3. Do you have any immune compromising diseases such as HIV (AIDS)? Yes / no

4. What home remedies have you tried? Patches / acids / ointments / shaving

5. Other doctors have tried? Laser / freezing / surgery / topicals / acids

6. How did you hear about us? Advertisement / web / friend / physician referral

What are warts?

Warts are skin growths caused by human papilloma virus (HPV) infection. They are contagious spreading

from one individual to another by a variety of mechanisms, from direct contact to aerosol spray. They are

frequently body part specific (such as the hands or the feet) without spreading to other areas. Many warts

seem to come and go at their own leisure. Others (venereal) are notorious for lasting a lifetime.

The primary reason for treating warts is the elimination of symptoms (including relieving cosmetic

concerns) and ultimately, removal of the warts. If left untreated, visible warts can resolve on their own,

remain unchanged, or increase in size or number

What are some types of common warts?

Dome-shaped warts: on the backs of fingers, toes, and knees.

Mosaic warts: Tiny, so-called "seed warts" can proliferate by the dozens or hundreds all over the

sole of the foot or hands.

Flat warts: These are small, flat, flesh-colored pimples and may be numerous on one part of the

body (for example on the face, arms, or groin).

Plantar warts are found on the bottom of the foot (the "plantar" part of the foot).

Periungual warts are warts around or under the nail.

Filiform warts typically appear as a single long stalk, often on the face.

Genital warts are transmitted during sexual contact and appear around the penis, vagina or anus.

What are some common treatments?

1. Salicylic-acid preparations : Salicylic acid is a keratolytic medication, which means it

dissolves the protein (keratin), which makes up most of both the wart and the thick layer

of dead skin that often tops it. This is usually over the counter.

2. Freezing: Cryotherapy with liquid nitrogen or cryoprobe. Repeat applications every 1–2

weeks. Aerosol sprays or liquid nitrogen freeze warts basically cause localized frost bite

at the treatment site.

3. Podophyllin: Podophyllin is a plant extract that is extremely caustic. It is used primarily

Wart Removal Consent Form