Consent for surgery/ procedure or treatment
Dr……………………………….,
As requested and to abide by all legal requirements, I would like
to :
- Confirm that I am fully aware of all major and minor risks involved
in all surgical procedures and particularly in…………….……..surgery,
which I would be undertaking.
- Declare that I have had the opportunity to forward my queries
regarding this procedure and I am now fully aware that this surgery,
like any other surgery, not only does it involve risks and complications
but also it is unpredictable in all aspects such as the length of
the operation, lesion marks and unexpected risks.
- Confirm that I am fully informed of all risks related to the
anaesthesia process. Any further information will be clarified when
I consult the anaesthetist.
- Declare that I have stated, to the best of my knowledge, all
up to date information related to all surgery undertaken, treatment
or medication.
- Confirm that I had all the information I needed in order to apply
for this surgery.
- Declare that both parties (myself and my surgeon) agreed to have
7 days time span between aknowledgment of the quotation and the
procedure.
- Declare that the decision to take up surgery is made on common
accord between :
- The patient who is fully informed of all risks and complication
and is genuinely motivated to undertake cosmetic surgery.
- The surgeon who has used his expertise to explain all the
techniques appropriate to his/her case and the terms and conditions
of the surgical procedure.
Once decision is made, the common concert agreement
aforementioned requires regular medical process, which allows the
surgeon to provide to his patient the best techniques available.
Post surgery side effects, if any, will then be discussed by both
the patient and the surgeon and treated to such standard as that
of the actual operation and post surgery.
I trust that you will use all means available to you to get to the
end results expected.
Yours faithfully
signature………………..on …./…./……
|
