Minor Surgery Consent Letter Samples

Letter -1

I am writing to inform you that your medical case is under my observation for the last week. I have been keenly observing and following it up too. I have received the last reports of your tests and scan today and with a heavy heart, I am informing you that there are 7 stones of different sizes in your gallbladder. I have attached the copies of your tests and scans with your letter so you may verify it too. 

Fortunately, the case is not complicated. However, you need to go to a minor surgery for which your consent is required. Before giving the consent, it is important for you to understand the procedure, the potential risks associated with this surgery, cost, pre, and post-care, post-diet plans, and some other things too.

I have prepared a detailed document on the things mentioned above for you to read and understand. I am attaching a copy of this document with this letter for your convenience.

Kindly go through it once and in case you do not understand any medical terms or any part of the procedure, please do not hesitate to call me at my number [x] or you may also visit me at my clinic tomorrow at 4:00 pm. We can discuss things further and get your signature on the agreement. I am sharing the terms and conditions of the agreement in this letter so you may have an idea of what a consent agreement looks like. The terms are as follows: 

  1. I Mr. [X] understands that I will undergo minor surgery to remove stones from my gallbladder.
  2. I hereby acknowledge that my Dr Nancy Miller has explained the procedure and potential risk associated with this surgery.
  3. I fully understand the procedure and give my full consent to my doctor to do whatever suits best in my interest to remove the stones.
  4. I also admit that if the stones are not removable I might have to get my entire gallbladder removed and I give consent for it. 

Kindly go through these clauses and the document attached with this letter and let me know when you are ready for it. Please do not delay your decision for more than a week. I look forward to hearing from you soon. Thank you for your understanding and cooperation. May you have a quick and healthy recovery. 

Minor surgery consent letter

Letter -2

I am writing in response to the phone call I received from your assistant regarding my medical condition. I have been told that I am diagnosed with ectopic pregnancy. There is a cyst in my ovary which needs removal. Your assistant has told me about the procedure, cost, and pre and aftercare about the surgery. She also told me that you need my consent to perform this minor surgery. 

I am ready to undergo this minor surgery. Kindly acknowledge this letter as my consent to perform this minor surgery. I also acknowledge that I will be given anesthesia for this procedure and I will be getting some blood transfusion. I allow you to do all that it takes to remove that cyst from my ovary. I also admit that this surgery has some potential risks like blood loss and losing an ovary in case the cyst is burst inside it. I still want you to remove it. 

I understand the procedure described by the assistant for this surgery and give my consent to do it. I would also like you to please give me an appointment prior to my treatment so I may ask you pre-empt questions and be satisfied to the fullest.

Kindly let me know if Tuesday 30th October at 4:00 pm suits you. I can also sign the consent form during my visit. In case you need any further documentation for this process, kindly let me know via email.

My email address is [x] or you may also give me a call at my number [x]. I look forward to hearing from you. Thank you for cooperating with me and for keeping me updated. Waiting for your response. 

Minor surgery consent letter

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