Minor Surgery Consent Form

Please complete this consent form if you have a minor surgery procedure booked in with one of the doctors and have been asked to complete this consent form prior to the date of the procedure.

If you are human, leave this field blank.

Full Name: *

Phone Number:

Briefly explain the procedure you are having (e.g. implant removal, cyst removal, skin lesion removal):

Date of Procedure:

Doctor carrying out the procedure:

There are a number of risks that are associated with minor surgery procedures. Some of these are listed below but this list is not exhaustive

Bleeding

Bruising

Increased pain

Infection

Incomplete removal of lesion

Scarring

I confirm that I am aware that as a result of this minor surgery procedure I may experience one or more of these risks

I confirm that I consent to having this minor surgery procedure carried out at Swallowfield Medical Practice

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Minor Surgery Consent Form

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