Surgeries are accompanied by risks and benefits, depending on the type of surgery to be provided and the condition of the patient. This is the reason why surgical consent forms must be prepared by surgeons and must be provided to the patient and the patient’s legal guardian.

Surgical Consent Form Sample

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What Is a Surgical Consent Form?

A surgical consent form is used by medical institutions and surgeons to document the consent and granted permission of a patient who will be undergoing surgery. In addition, this type of consent form is not only limited for surgery patients but also individuals who are known as the legal guardian of the patient, as well as the owner of a pet who needs surgery to treat a condition. The form also allows the patient to be knowledgeable about the effects of the surgery and the details of the surgical procedure.

Anesthesia Surgery Treatment Consent Form

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Animal Clinic Surgical Consent Form

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Canine Surgical Consent Form

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Laser Eye Surgery Consent Form

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Varieties of Surgical Consent Forms

Minor Surgery Consent Form – Surgeries are categorized into two basic groups: either a minor or major surgery. For minor surgeries, a minor surgery consent form will have to be signed by the patient. In this form, the patient will need to state his name, date of birth, gender, addresses, and phone numbers along with his signature to indicate his consent for the procedure to be provided by his general practitioner or surgeon.

Minor Surgery Consent Form

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Patient Information and Surgical Consent Form – This surgical consent form not only documents the consent granted by the patient but also his personal information and details which are necessary to be known by the surgeon. The form is composed of thirty-two pages which contain details about the surgical procedure, frequently asked questions or FAQs, and liability releases. The information to be disclosed by the patient, on the other hand, is his name, address, date of birth, age, gender, and the name of his consultant. Moreover, the types of diseases that the patient have had, the media release permitted by the patient, the donation preferences and information of the patient, and the transplants that the patient have undergone before will also be included in the form. In addition, the patient’s consultant must also fill out the consent portion of the form which is for indicating his approval and affirmation to the need of the transplant and the information stated in the form.

Patient Information and Surgical Consent Form

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Pet Surgery Consent Form and Questionnaire Form – This is the variety of consent form intended to be signed by a pet owner for a pet or an animal who needs to undergo surgery and medical treatments. In the form, the pet owner must state the name of his pet or animal along with its age, and the procedure to be fulfilled. The medical history of the pet, sedation history, heartworm prevention information and the medications which are administered to the pet will also have to be disclosed in the form along with the verification and affirmation of the staff of the animal clinic.

Pet Surgery Consent Form and Questionnaire Form

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Surgical Abortion Informed Consent Statement Form – Surgical abortion is a method of ending a pregnancy in a safer way as compared to other abortion methods. However, before a surgeon or any medical professional executes a surgical abortion procedure, the patient must first fill out a surgical abortion informed consent statement form. This document contains four sections which should be completed by the patient and her legal guardian if she is a minor, and the medical practitioner himself. In the first section, the patient’s name, date of birth, and address will be stated while the second section is where the patient must indicate what items or subjects and information have been provided to her by the practitioner. The third section of the form is where the patient and her legal guardian will affix their signatures to indicate their consent. On the other hand, the fourth section or the medical practitioner statement section is for the medical practitioner’s signature, name, and council registration number.

Surgical Abortion Informed Consent Statement Form

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Surgical Consent and Liability Release Form – This is another form which is used by animal and pet hospitals or clinics, and contains two pages. The purpose of a surgical consent and liability release form is not only for documenting the authorized consent of the pet owner but also the pet owner’s affirmation in releasing the clinic from any liabilities. The pet owner’s name, address, and contact information will have to be inputted in the first portion of the form’s first page while the pet’s data will be the focus of the second section. Questions regarding the pet’s veterinary history, medications, and illnesses will have to be answered by the pet owner in the third section of the form. The fourth section contains the acknowledgment statements to be agreed and be signed by the pet owner. Additionally, the second page of the form is allotted to be filled out by the clinic staff wherein the observations and physical examination results of the pet will be enlisted.

Surgical Consent and Liability Release Form

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Essential Contents and Data to Include in a Surgical Consent Form

Regardless of the variety of consent form that surgeons and clinics will be used for their patients, the following data and contents should always be included and be disclosed in the form:

  • The patient’s data and information: This not only refers to the patient’s name and address but also the patient’s contact details, emergency contact person, and lifestyle details. The sole purpose of obtaining the patient’s information and data is to know the patient more and properly identify who the owner of the consent form is.
  • Patients medical history: The patient’s previous health status, medications, treatments, and other medical history information which should be known by the surgeon should be included in the form. The medical history will allow the surgeon in determining what products or medications will be harmful to the patient due to illnesses and possible allergic reactions.
  • Consent and permission statement: This portion of the form is where statements about the patient’s consent will be indicated. The statements must also be accompanied by a signature block for the signatures of the parties involved in the surgery, such as the surgeon, the patient, and a witness or the patient’s legal guardian. In addition, an area for indicating the date when the form was completed is also essential to be incorporated in the signature block.

Physician’s Surgery and Procedure Consent Form

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Pre-Surgical Consent Form

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Surgery Operation Procedure Consent Form

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Surgical Procedure Medical General Consent Form

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In addition, an area for the verification and the validation of the surgical clinic staff can also be included in the form which is for indicating the dates when the form was received and when the date of the surgery will be. The staff will also be responsible for recording and keeping the form along with other medical forms and documentation of the clinic.

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