You are considering a circumcision procedure on a newborn child whom you are legally responsible for. Complications from circumcision are uncommon, but they do sometimes occur. There is also natural variation from person to person. Because of these facts, there is no guarantee as to the desired cosmetic result that might be obtained from this procedure.
Bleeding, infection and injury to the penile anatomy are possible complications of this procedure. There may not be as much foreskin removed as is preferred. I certify that I have read the contents of this form; I understand the risk involved with this procedure.