I, the below named PATIENT or Authorised person, confirm that I have had a discussion with the treating Doctor about the risks and benefits of the above listed procedure(s). I have confirmed that the site, side and procedure(s) above are correct. I have the capacity and authority to provide informed consent. I understand the risks and benefits as they relate to me (or the above listed patient) and I have made the informed decision to proceed with the above listed procedure(s)..
I, the below named DOCTOR, confirm that I have had a discussion with the above named patient about the risks and benefits of the above procedures. I have outlined the treatment choices to the patient and have answered all relevant questions..
