I understand that my physician may discover other or different conditions which require additionally or different procedure than those planned. I authorize my physician and such associates, technical assistants and other health care providers to perform such other procedures which are advisable in their professional judgement.
I understand that no warranty or guarantee has been made to me as to result or cure.
Just as there may be risks and hazards in continuing my present condition without treatment there are also risks and hazards related to the performance of the surgical, medical and or diagnostic procedure(s) planned for me. I realize that common to surgical medical and/or diagnostic procedure(s) is the potential for infection, blood clots sin veins and lungs, hemorrhage, allergic reactions, scarring and even death. I also realize that the following risks and hazards may occur in connection with this particular procedure: