Consent for Minor Surgery - Excision of Wart/Skin Tag/Lesion for Biopsy

Statement of Health Professional

I have discussed the procedure and any available alternative treatments (including no treatment) with the patient. In particular, I have explained:

• The nature of the procedure proposed (including what it is likely to involve)
• The need and intended benefits
• The use of local anaesthesia as necessary
• Postoperative care
• Serious or frequently occurring risks including: Permanent Scaring, Altered Sensation, Pigmentary Changes, Infection, Post-Operative Bleeding, Nerve Damage, Recurrence

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Statement of Interpreter (where appropriate)

I have interpreted the information above to the patient/parent to the best of my ability and in a way which I believe they can understand.

Statement of Patient/Person with Parental Responsibility for Patient

I confirm that the nature, benefits, and risks of the proposed treatment have been discussed with me as above and I agree to proceed.