REED CENTRE forAmbulatoryUrologicalSurgery

1111KANECONCOURSE,BAYHARBORISLANDS,FLORIDA33154
Phone(305)8652000/Fax(305)8652002

INFORMEDCONSENTFORLABIAPLASTY

1.

IherebyrequestandauthorizeDr.HaroldM.Reed,whomay
be assisted by his designated urological associates and
surgical technicians, to perform the urological operation
entitled"Labiaplasty"inanefforttoreduceandrestorea
more delicate appearance to my labia which may include
clitoralhood,labiamajoraandlabiaminora.

2.

Dr.Reedhasdiscussedhiscaseexperiencewithmebuthas
not made any promise of a specific performance, or
guaranteedwhetherexpressedorimplied,aspecificresult.
Postoperative swelling of the labia, bruising and some
spottingmaybenotedandmaylastuptosixweeks.Minimal
areasofnumbnessmayoccurlastingforafewweeks.

3.

Intendedareaofincisionshasbeenshowntomeduringmy
examinationandmedicalillustrations.

4.

Irecognizethatthereareinherentrisksinallsurgical
procedures and can appreciate the possibility of side
effectsandcomplicationsstemmingbothfromtheprocedure
and recovery therefrom including but not limited to
hematomawhichisalocalizedcollectionofbloodorblood
clot, infections, neurological numbness stemming from
possibleneurologicalinjuryalthoughIknowDr.Reedwill
takeeveryprecaution.

5.

Igivepermissionforgenitalphotographybefore,during,
andaftertheprocedure,andagreethatthesephotographs
shall be property of Dr. Harold M. Reed, and may be
utilized for, but not limited to: publication in
scientificjournals,orpresentedforscientificreasonsor
inamannerdirectlyrelatedtothepracticeofmedicine.

6.

I will call Dr. Reed immediately if there are any

concernsandkeepmyappointmentswithhim.

INFORMEDCONSENTFORLABIAPLASTY
(page2)

7.

Ihavediscussedthisprocedurewithmysexualpartneror
significantotherandhavegainedtheirapproval,orafter
careful consideration of my situation and relationship I
havedecidedtoproceed. Iandmypartnerareawarethat
there will be a period of sexual abstinence, and can
appreciate the emotional consequences of this hiatus, as
wellasanyunanticipatedcomplicationsstemmingfromthis
procedure. I have any significant emotional disorder
presently.

8.

I understand the maintenance of personal hygiene,

especially genital cleanliness is extremely important in
preventingpostoperativeinfection.

9.

I have abstained from smoking for 2 weeks prior to this

procedure and will abstain for 2 months following this
procedure.

10. IunderstandthatIamtobeinaconvalescentstatuswith
agenerousamountofbedrestfor2daysaftersurgery.For
onemonthaftersurgeryIwillnotengageinany stressful
physical activity including excessive bending, lifting or
participation in anysports. Iwillabstain from sexual
relationsforfiveweeksfollowingsurgery.
11. IamawarethatDr.Reedhaselectedundertheprovisions
of Florida State Law not to carry professional liability
insurance.
I have read and signed the above consent in the presence of a
witness whose signature appears below, after I have had an
opportunitytoquestionsDr.Reedregardinganyunfamiliarmedical
terminology.
Dr.ReedhasaproprietaryinterestinthisCentre.Youmaywish
toconsideralternativesitesforevaluationandtreatment.

INFORMEDCONSENTFORLABIAPLASTY
(page3)

PATIENT
DATE
TIME

__________________________________________________________________

WITNESS

Ihavepersonallydiscussedwiththepatienttheabovedescribed
proposedsurgery,itsrisksandpotentialcomplications,aswell
asthealternativesavailable.

_________________________
HAROLDM.REED,M.D.

(CONLABIAPLASTY)