Cosmetic Surgery Consent Form
Patient Information
Full Name
Date of Birth
Phone Number
Address
Procedure Details
Procedure Name
Date of Procedure
Surgeon Name
Medical History
Relevant Medical History
Consent
I confirm that I have been fully informed about the procedure, its risks, benefits, alternatives, and possible complications.
I give my consent for the cosmetic surgery as described above.
Patient Signature
Date
Witness Signature
Date