ORDRE DES CHIRURGIENS DE GENEVE

 

Dr. Claudio SORAVIA

34, avenue Eugène-Pittard

1207 Genève

Phone +41 2 786 32 92

 

GENERAL PROCEDURE CONSENT FORM

 

1.I consent to the following procedure being performed upon me.

 

2.The anticipated nature, expected benefits, risks, and side effects of such procedures and alternative course(s) of action have been explained to me by Dr Claudio SORAVIA including the consequences of not having the treatment.

 

3.I confirm that I understand and am satisfied with the explanations I have been given and I have received responses to my requests for additional information.

 

4.I consent to all preliminary and related procedures and to the administration of general and/or other anaesthetics and to such additional or alternative procedures as may be considered medically necessary during the course of the above procedure(s).

 

I declare that I have read the above consent to surgical operation, diagnostic test or medical treatment or it has been read and explained to me and I fully understand the same and agree to its contents.

 

Swiss law is applicable and juridiction is Geneva.

 

Geneva, Date : 

Signature of patient :