Skin Procedures Consent

HFGP Consent Form For Skin Procedure

Your GP has recommended an excision or skin procedure

Patient Details

First name *

Surname *

Date of Birth *

It is important to understand the risks and benefits of any medical treatment. This form helps us help you with your understanding.

Please read and cross the below statements to indicate that you have been told of these complications and understand their implications.

My treating Doctor has discussed with me the risks and the possibility of complications, including :

Unusual effects including nerve damage, permanent pain *

Infection *

Bleeding and slow healing *

Poor scarring and wound breakdown *

Recurrence of the lesions *

Allergic reaction to the local anaesthetic *

By signing this form, you confirm that:

I have discussed my present condition with my doctor and the various ways it might be treated, including the above procedure and treatment, or referral to a specialist *

I have been given the opportunity to ask questions relating to this procedure and I am satisfied with the explanation and the answers to my questions. *

I give consent for my treating doctor to administer any appropriate medications or treatments they deem necessary in the event of a medical emergency arising out of the treatment. *

I understand that in the event of an emergency during the procedure e.g, should i have a reaction or unexpected bleeding, I will be treated, and if needed an ambulance called, and sent to hospital (this may incur extra costs) *

I understand that additional procedures or treatments may be needed if the doctor finds something unexpected. *

I understand I may withdraw my consent. *

I have discussed with my doctor and understand the fees involved, which includes the cost, rebate and out of pocket expense, of the treatment *

Signature *

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Date *