Patient Agreement

Please read each item below and select box provided to show that you understand each item. *These must also be completed by the parent or guardian of a minor patient (under age 18). Do not sign this consent and do not take SORIATANE (aka Neotigason; generic name, Acitretin) if there is anything that you do not understand.


Yes - Proceed to the next statementNo - Skip to statement 5


I understandI do not Understand


I am not sexually activeI am sexually active and will use 2 forms of contraceptionI am sexually active and will NOT use 2 forms of contraception


I understandI do not Understand


I understandI do not Understand


I understandI do not Understand