Get Signed Informed Consent Before Every Cosmetic Surgery

This cosmetic plastic surgery informed consent template gives your practice a structured way to document what each patient is agreeing to before they reach the operating room. It starts with patient and procedure details, including date of birth, contact information, planned cosmetic procedures, the operating surgeon, and the scheduled surgery date. Next, it captures medical history, the planned anesthesia type, relevant health conditions and risk factors, and a complete list of current medications, supplements, and any drug, latex, or anesthesia allergies.

The form is built for plastic surgeons, cosmetic surgery practices, ambulatory surgery centers, and anesthesia providers who need clear, consistent pre-operative documentation. After reviewing the risk information, patients confirm that each surgical and anesthesia risk has been explained to them, flag any items they still have questions about, and describe those concerns so your team can follow up before the procedure. They also agree to follow pre-operative instructions, including fasting guidelines, stopping nicotine and any medications or supplements as directed, and arranging for a responsible adult to drive them home and stay with them for at least 24 hours after sedation or general anesthesia.

The final section lets patients choose how their before-and-after clinical photographs may be used, record their blood transfusion decision, and sign electronically. Going digital reduces paperwork, eliminates illegible handwriting, and keeps signed consent records organized and easy to retrieve. Customize the procedure list, risk statements, and wording to fit your practice, and have your legal or compliance advisor review the final version before use.