B. CONSENT FOR ANESTHESIA
When local anesthesia and or sedation is used by the provider: I consent to the administration of such local anesthetics as may be considered necessary by the provider in charge of my care. I understand the risk(s) of local anesthesia include but are not limited to: local discomfort, swelling, bruising, allergic reactions to medications, and seizures from lidocaine.
C. PATIENT CERTIFICATION:
I have received information about my condition, the proposed treatment, alternative(s), and related risk(s). This form contains a summary of this information. I have received an explanation of any unfamiliar terms and have been offered the opportunity to ask questions. I understand I may refuse consent at any time. I have read and understand this form, and I give my informed and voluntary consent to the proposed procedure(s). I also consent to the performance of any additional procedure(s) determined by my provider during the procedure(s). By signing below, I state that I am 18 years of age or older, or otherwise authorized to consent.