Cosmetic Surgery Consent Form
Patient Information
Full Name
Date of Birth
Address
Phone Number
Email
Procedure Information
Description of Procedure
Surgeon's Name
Medical History
Relevant Medical History
Allergies
Consent
I acknowledge that the procedure has been explained to me, including possible risks and complications.
All my questions have been answered to my satisfaction.
I give my consent voluntarily and understand I may withdraw at any time.
Patient Signature
Physician/Witness Signature