<h1 style="text-align: center;"><strong>&nbsp;<span style="font-size:36px"><span style="font-family:Times New Roman,Times,serif">PRIME SPECIALIST CLINIC, KANO</span></span></strong></h1>

<p style="text-align: center;"><strong><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:16pt">19 Lamido Crescent, off Tarauni, Kano.</span></span></strong></p>

<p style="text-align: right;"><strong><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:16pt">RC: 1285352</span></span></strong></p>

<p style="text-align: center;"><strong><span style="font-family:Times New Roman,Times,serif"><span style="font-size:22pt">SURGICAL CONSENT </span></span></strong></p>

<p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;I am signing this document with full knowledge of its contents. I absolutely agreed for the medical team to carry out all necessary investigations concerning (my/my wife&#39;s/relative&#39;s/child&#39;s) ailment including ultrasound scanning, lumber puncture, etc. and also to carry out surgical intervention on (me/my wife/my relative and/or child).</p>

<p>I understood that during surgical procedures and anesthesia, there could be unforeseeable consequences and complications.</p>

<p>I know that surgical procedures carry risks of bleeding, infection, cardiac disturbance and even negative outcomes. Prior to signing this consent, I (parent/relative) had a discussion with the (doctor/ doctors) and the (doctor/doctors) explained to (me/us) about (my/ my wife&#39;s/ my relative&#39;s/ child&#39;s) health&#39;s condition and on (form/ forms) of</p>

<p>Treatments; explained what exactly would be done during the surgical manipulations; informed us on the other forms of treatment for this particular ailment and the advantage of the chosen treatment.</p>

<p>(1/ we) understood that in some circumstances, there could be a need for a repeat surgical procedure in which I agreed. (I/ we) know that (I am/ we are) obliged to notify the (doctor/ doctors) about all health&#39;s problems including allergic reactions prior to and during post-surgical rehabilitations periods.</p>

<p>In case of blood lost, I agreed for blood transfusion to (meet my wife/ my relative/ my child). In situation of blood deficit from blood banks, (me/ us) the relatives are informed and agreed/ ready to provide blood and other medications during surgery or during post-surgical rehabilitation.</p>
