Medical Treatment Agreement
The undersigned:
The foundation Skin & Vision Clinics (hereinafter: Skin & Vision Clinics), established in Amsterdam, lawfully represented and also acting on behalf of the medical specialists affiliated with its clinic who, according to the patient record, are involved in the treatment of the patient, hereinafter referred to collectively as: “the clinic et al.” and individually as: “the clinic” and “the specialist”;
and
The natural person known under the name stated on the email with which this agreement was sent and residing at the address stated in the patient record, hereinafter referred to as: “the patient”;
Considering:
- that the patient instructs the specialist and the clinic to perform a medical treatment aimed at reducing or remedying functional complaints of the face or eyelids, as established in the referral letter provided to the clinic;
- that the parties consider it desirable to set out their mutual rights and obligations in this medical treatment agreement.
Have agreed as follows:
Duty of care of the practitioner and the clinic
In performing this agreement, the specialist and the clinic observe the care of a good care provider and act in accordance with the responsibility resting upon them.
If necessary, the specialist or clinic may have additional diagnostics or assessment carried out by a competent physician outside the clinic, provided this is in the interest of careful decision-making.
Awareness of and agreement with the treatment agreement and terms and conditions
The patient receives this treatment agreement and terms and conditions prior to the appointment.
The patient is expressly asked to agree before the treatment, for example by signing or by ticking agreement in the digital record.
The patient has had the opportunity to ask questions and, by agreeing, declares to have been sufficiently informed.
Patient's duty to inform and cooperate
The patient provides all information that is reasonably necessary for proper treatment and cooperates as much as possible by following advice and instructions.
Duty to inform of the specialist and the clinic
The clinic and/or specialist informs the patient in an understandable manner, and on request in writing, about:
- the necessary examination and/or treatment,
- the procedures to be performed,
- the expected consequences and risks,
- alternative treatment methods,
- the intended result.
If providing information would cause serious harm to the patient, or if the patient explicitly does not wish to receive information, this may be waived.
Confidentiality
The clinic and specialist do not provide information or access to third parties without the patient's consent, unless legally required. Medical procedures take place outside the observation of others, unless the patient expressly agrees to this.
Consent by/on behalf of the patient
On the basis of the information provided, the patient gives consent for the treatment discussed, as recorded in the file.
This consent includes calling in other experts if necessary, regardless of the specialism.
Consent can always be withdrawn.
If a more invasive procedure proves necessary during treatment, additional consent is always requested first, unless the patient has designated an authorised representative in advance.
On request, it is recorded in writing for which procedures consent has been given.
In case of emergency or unforeseen situations, where reasonably no other option is possible, this consent procedure may be deviated from, in accordance with statutory provisions.
Medical record
The clinic maintains a medical record containing data on health, procedures and relevant documents.
On request, the clinic adds a written statement from the patient.
The record is kept for at least fifteen years, as required by law.
The patient has the right to inspect and obtain a copy, with the exception of personal working notes and insofar as the privacy of others is not harmed.
On request, data is destroyed within three months, unless the law opposes this or the data is of importance to third parties.
Personal data is processed in accordance with applicable legislation, including the GDPR. This data is used solely for the performance of the treatment and is not shared with third parties without consent, unless legally required.
Liability
The clinic and/or specialist are liable for damage resulting from shortcomings in all acts that take place under this agreement within the clinic.
There is no limitation or exclusion of liability.
Payment
The patient is responsible for payment of the invoices for the treatment. Invoices are sent and collected on behalf of the clinic et al. by Infomedics, in accordance with their applicable terms and conditions.
The patient receives these terms and conditions prior to the treatment, and they can be found at www.infomedics.nl.
Termination
The patient can terminate the treatment agreement at any time. The specialist or the clinic can only terminate the treatment agreement for compelling reasons, for example in the case of a seriously disrupted treatment relationship, threats to staff, or if the treatment has become medically irresponsible.
A note is made in the patient record of the conclusion of this agreement. This is apparent from the report of the first consultation.
Version 1.0, adopted on 21 July 2025