Cosmetic Surgery Consent Form
Patient Information
Full Name
Date of Birth
Address
Phone Number
Procedure Details
Name of Procedure
Date of Procedure
Surgeon/Physician
Consent and Acknowledgements
I acknowledge the nature and purpose of the procedure have been explained to me, including risks & alternatives.
I understand that results are not guaranteed and that complications can occur.
All my questions about the procedure have been answered to my satisfaction.
Patient Signature
Date
Witness Name
Date