Consent Form for Gynecology Minor-Surgery Treatment



Patient Name :
Signature

Witness Name
Witness Signature
Date

HEALTHCARE PROFESSIONAL DECLARATION

I have adequately explained to the client about the procedure and the risks, adverse effects, and the standard alternatives available for the procedure. I have permitted time and opportunity for the client to ask questions, and all questions have been answered.

I have informed the client/next of kin about the following:


Doctor Name
Signature