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Acne, ACCUTANE and You
About Informed Consent
Please sign a consent form before taking ACCUTANE
The consent form is a policy requirement for taking ACCUTANE. Signing the consent form, or having your parent or guardian sign it on your behalf, tells your doctor that you understand all the information you have received from your doctor about ACCUTANE.

If you are male, you must read and sign Part I of the form. If you are female, you must read and sign Part I and Part II of the form.

Your doctor should explain all the information in the consent form to you, and you should also read it over carefully before you sign it. If there is anything you don’t understand in the consent form, ask your doctor about it before you sign the form.

When you have signed the form, give one copy to your doctor to keep in your medical file and keep one copy for yourself.

Download ACCUTANE Informed Consent form

You’ll need Adobe Reader to view or print this document. If you don’t already have it on your computer, you can download it for free.

Questions or concerns about taking ACCUTANE?
Talk to your doctor or call the Roche Medical Information Department (toll-free) 1-888-762-4388.
Accutane
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�2024 Hoffmann-La Roche Limited. All Rights Reserved.   AcneandU.ca is a service provided by Roche Canada.
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This website is neither intended nor designed to record or report adverse event information. If you have a suspected side effect or problem to report regarding a Roche product, please email [email protected] or call 1-888-762-4388. You can also report adverse events relating to any product to Health Canada directly by going to the Canada Vigilance Program website at https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting.html.

This material was developed by Hoffmann-La Roche Limited, as part of the risk minimization plan for ACCUTANE. This material is not intended for promotional use.
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