Operation Notes

Operation Notes Form

Patient Information

Next of Kin

Surgeon / Doctor

Please read and understand.

1. I confirm that the doctor has explained the procedure to me and I understand the diagnosis.
2. The nature and purpose of the procedure, plus the appropriate available options have been explained to me. I have had adequate opportunity to ask questions and these have been answered to my satisfaction.
3. I consent to the performance of the above named procedure and other necessary additional procedures in my best interest in the judgment of the doctor.
4. I consent to the administration of anaesthesia explained and advised by the doctor and to the administration of such further administration of anaestheasia  as may be considered necessary by the doctor during the course of the procedure.

Patient Signature

N.O.K Guardian Signature

Anesthesiologists Signature