Informed Procedure Consent

Understand that by signing this form, I am acknowledging that I have been informed about the following procedure/treatment:

I have had an opportunity to review the consent binder provided by the practice regarding this procedure/treatment in its entirety and understand the process and associated risk.

I have had an opportunity to ask the doctor questions about the procedure/treatment and do not need any additional clarification.

I have disclosed my medical history, current medical conditions, current medications and known allergies to the practice.

I acknowledge that I have read this consent form and fully understand it.

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