You have the right to be informed so that you may make the decision whether or not to undergo the procedure(s) after knowing the risks and hazards involved. This disclosure is not meant to frighten you, it is simply an effort to make you better informed so you may give, or withhold, your consent to the procedure.
Please read the statement below and mark each statement, to indicate you understand them completely. As a client, it is your responsibility to inform the service provider of all possible concerns before they begin your procedure.