• Surgical Consent Form

  • Date of Birth*
     - -
  • My surgery is going to be undertaken by
  • Do you consent to the assisting nurse to undertake part or all of the procedure with adequate doctor supervision
  • Procedure/s you are booked in for
  • Alternative procedure/s discussed that you consent to being undertaken if it is the recommended on the day of surgery
  • There is a risk of bleeding, scarring, infection, wound dehiscence and the possibility of further surgery being required. I understand the risks of the procedure*
  • I understand that I can ask questions, request more information or discuss the recommended procedure and that treatment options include having the procedure at The Skin Hub, being referred to another provider or declining treatment:
  • I have made arrangements to avoid physical or strenuous following my procedure and agree to comply with the post-operative instructions provided by The Skin Hub

  • We recommend only undertaking light duties for 2 weeks following your procedure to reduce the risk of dehiscence and/or infection. This means avoiding physical or strenuous activities, especially activities that may stretch or disturb your wound.

     

    Activities such as golf, yoga, swimming and other sports are not recommended. 

     

    If this is difficult for you to arrange, please discuss this with our clinical staff prior to surgery.

  • Do you have any special requirements regarding your specimen (i.e. you would like it returned to you)?
  • Do you consent to this procedure*
  • Preferred day/time for surgical booking (please select all days you are available)
    Rows
  • Should be Empty: