I understand that the surgical treatment I'm seeking is not a substitute for more comprehensive medical diagnosis or treatment of more serious or systemic conditions for which I should see my physician or other qualified medical specialist. I also understand that I am responsible for seeking diagnosis and treatment for any mental or other physical ailment that I am aware of from my physician or other qualified providers. Because male breast reduction procedures may not be advisable to be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly and understand that no treatment is guaranteed to produce a specific result. I agree to keep Dr. Edwin Ishoo and Boston Cosmetic Specialists updated in writing as to any changes in my medical profile and understand that there shall be no liability on Dr Edwin Ishoo or Boston Cosmetic Specialists and should I fail to do so. I also understand and confirm that submission of this form does not constitute nor establishes a doctor-patient relationship with Dr. Edwin Ishoo.