Consent Form for the Use of Exosomes in Treatment

Consent Form

for the Use of Exosomes in Treatment
Patient Name*
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Doctor Name
Treatment Facility
Date*

MonthDayYear
PURPOSE
This consent form serves to inform you about the use of Exosomes in your treatment and to obtain your permission to proceed with the treatment.
Description of Treatment
Exosomes are vesicles that are released by cells and play a role in intercellular communication. They have potential therapeutic applications, and your physician has recommended their use in your treatment.
Potential Benefits
While outcomes vary from patient to patient, potential benefits of this treatment might include:
- Improved cellular function and communication
- Acceleration in healing processes
- Other therapeutic effects as discussed by the physician
Acknowledgment and Consent*

I, the undersigned, have read this consent form (or it has been read to me) and I have had the opportunity to ask questions and all my questions have been answered to my satisfaction.I understand the nature of the Exosomes treatment, its potential benefits, risks, side effects, and alternatives. I also understand there are no guarantees regarding the outcome of this treatment.I hereby give my informed consent to proceed with the Exosomes treatment as described above.
Patient Signature*

Clear
Date*

MonthDayYear
Doctor Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Consent Form