Scribd Logo
Upload

Welcome to Scribd!

  • Consent Form

    Uploaded by

    Joshua Ajewole
    9 views2 pages
    Dr. Oj Ajewole is a specialist family physician practicing in Pretoria, South Africa. His practice address and contact information is provided, including his practice location, postal address, telephone numbers, email, and fax. The document also provides a template consent form for patients to sign agreeing to a procedure and administration of anesthesia, with spaces to fill in the patient's information, details of the procedure, and signatures of the patient, witness, and surgeon.

    Original Description:

    CONSENT FORM TEMPLATE

    Original Title

    CONSENT FORM

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Dr. Oj Ajewole is a specialist family physician practicing in Pretoria, South Africa. His practice address and contact information is provided, including his practice location, postal address, telephone numbers, email, and fax. The document also provides a template consent form for patients to sign agreeing to a procedure and administration of anesthesia, with spaces to fill in the patient's information, details of the procedure, and signatures of the patient, witness, and surgeon.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    9 views2 pages

    Consent Form

    Uploaded by

    Joshua Ajewole
    Dr. Oj Ajewole is a specialist family physician practicing in Pretoria, South Africa. His practice address and contact information is provided, including his practice location, postal address, telephone numbers, email, and fax. The document also provides a template consent form for patients to sign agreeing to a procedure and administration of anesthesia, with spaces to fill in the patient's information, details of the procedure, and signatures of the patient, witness, and surgeon.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    DR.

    OJ AJEWOLE SURGERY
    MBBS(Lag) MMed. Fam Med (Wits)
    SPECIALIST FAMILY PHYSICIAN
    PR No: 0478946 MP0602914

    Practice Address. Postal: PO Box 29050,


    Unit G17A, Barclays Square Shopping Centre, Sunnyside. 0132.
    296, Justice Mohamed Street, Tel: 0124401305 Cell:0820479791
    Sunnyside Email:drojajewole@telkomsa.net
    Pretoria Fax:08654444602
    0002

    CONSENT TO PERFORM A PROCEDURE AND ADMINSTRTION OF ANAESTHESIA


    I, ID No,

    Cell, Address,

    Hereby consent to the performance of

    (name of procedure) and administration of an anaesthesia, the nature of which all


    have been explained to me and I fully understand. I leave the extent of the procedure
    to the discretion of the surgeon.

    Signature of patient/caregiver Witness

    Date Date

    Signature of Doctor/Surgeon

    Date

    You might also like