A surgical consent form is considered as the medical commitment between the patient and the concerned surgeon, hospital and clinic to initiate the surgical treatment.
Sample surgical consent form:
* Name of the hospital: _______________________
* Hospital Address: _________________________________
* Name of the surgeon: _______________________
* Name of the patient: ________________________
* Type of the surgery: ________________________
* Surgical consent terms:
Have you understood the cause of surgery: _________________?
Have you met your surgeon: ________________________?
Are you ready for the surgery: _______________________?
Are you fully aware about the consequences if the surgery fails: _______________?
Is your family, relatives and guardian aware about your surgery and post surgery requirements: ____________?
Are you taking all the medicines suggested to you before the surgery: ______________?
Have you paid the 50% of the amount for your surgery: _____________________?
Are you taking the full responsibility of your surgery results: ____________?
* Signature of the patient: ____________________
* Signature of the guardian, if minor: ___________
* Signature of the surgeon: __________________
* Date: ___/____/____