REINFORCED MUTUAL CONSENT FOR AESTHETIC SURGERY
As you asked me to make and meet legal obligations, it is with great pleasure that:
I confirm that you have outline in detail:
- serious risks to any particular surgical procedure including vital ones,
- serious risks individuals to the intervention that I must undergo and which should be indicated on the quote including vital ones.
A certain percentage of complications and risks, including vital not only related to the illness I suffer and to the morbid associations I suffer but also unpredictable individual reactions.
From my side, I have informed you, truly and fully, about operations, care, treatments and medications I have followed so far, as well as complications I’ve had.
I also understand that I was able to ask any questions about this operation and I have taken note, in addition to the risks above mentioned, that there is an unpredictable time, different aspects and forms such as: loco-regional anatomy, of healing, etc,,,, as well as exceptional risks, even unknowns.
You have informed me of the benefits of the operation and therapeutic alternatives as well as the eventual possibility of revisions.
I acknowledge having received, read and understood the information sheet of the French Society of Plastic, Reconstructive and Aesthetic Surgery given to me related to my surgery.
I confirm that the explanations you have provided have been sufficiently clear to allow me make my choice and ask you to perform the surgery.
I also have been warned that during surgery the surgeon may be faced with a discovery or an unforeseen act imposing additional or different techniques from those initially planned and I authorize the surgeon now and already in these conditions to perform any act he/she deemed necessary, or even be assisted in this by another practitioner.
I recognize that the time between the consultation date and the date of the procedure seems quite adequate and, in the meantime, you’re at my disposal to answer any question and of my doctor.
I expressly agree to make your queries and to me, submit too all recommendations that you care and I were prescribed for pre- and postoperatively.
I give my permission to be filmed and/or photographed for diagnostic purposes, research or medical documentation. This document may be used only for scientific meetings, medical training or research, excluding any other distribution.
I trust you to use all means at your disposal to approach the desired result.