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5. I have also discussed with the surgeon all the common risks / complications of the operation. |
| Initial if you understand and agree ....................... |
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6. The following have also been carried out:
• I have met the surgeon.
• I have discussed the technique the surgeon will use for my operation.
• I know how long the operation is going to take.
• I know the cost of the operation and mode of payment.
• I know all fees for surgery has to be paid before the surgery and the deposit paid is not refundable after surgery has been carried out.
• I know when I can return to normal activity after operation. |
| Initial if you understand and agree ....................... |
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7. Dizziness may occur during the first week following surgery, particularly upon rising from a lying or sitting position. If this occurs, extreme caution must be exercised while standing. Someone must be present when you shower during the early post-operative period. Do not attempt to walk if dizziness is present. |
| Initial if you understand and agree ....................... |
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8. I understand that secondary revisions or additional surgeries may be required in some cases. The cost of any of these additional surgeries varies from zero to one-half the original surgeon's fee. I understand that I will also be required to pay the additional anesthesia and operating room fees. |
| Initial if you understand and agree ....................... |
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