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Consent for Cervical Polyp Removal - shifa101 - The Shifa Clinic

Consent for Cervical Polyp Removal - shifa101 - The Shifa Clinic 2026

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The document is a consent form for the removal of a cervical polyp, authorizing Dr. Reshma Khan or an authorized physician to perform the procedure. It outlines the nature and purpose of the surgery, potential risks, alternative treatments, and post-operative expectations. The patient acknowledges understanding the information provided, including possible complications and their right to refuse treatment.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and the date at the top of the form. This personalizes the document and ensures clarity.
In the section where you authorize Dr. Reshma Khan, clearly state your consent for the procedure. Ensure that all fields are filled accurately.
Review the information regarding risks and alternative treatments carefully. Acknowledge your understanding by checking any required boxes if applicable.
Sign and date the form at the bottom, ensuring that you have read and understood all sections before signing.
If required, have a witness sign in the designated area to validate your consent.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who can remove a cervical polyp?

Your healthcare provider may perform the surgery in a surgical center or operating room with anesthesia (if the polyp is large). Your provider removes small cervical polyps by pulling or twisting them off with a pair of forceps.

What type of doctor removes polyps?

Surgeons can perform minor operations through the scope. In certain, more difficult cases, your surgeon may need to access a polyp through your abdomen. They can do this through minimally invasive surgery methods, such as laparoscopy.

Who removes cervical polyps?

In-office polypectomy is a popular procedure used to deal with cervical polyps. It is performed by an OB/GYN to help women get rid of these non-cancerous growths.

How much does it cost to remove a cervical polyp?

Treatment. The provider can remove polyps during a simple outpatient procedure. Smaller polyps may be removed with gentle twisting. Electrocautery may be needed to remove larger polyps.

Can a gynecologist remove polyps?

The gynecologist guides the hysteroscope into your , through the , and into the . Gas or saline is released through the scope to inflate your , allowing for better visualization. The physician will remove any polyps with special scissors, a laser, or another device that uses electricity.

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Can cervical polyp be removed in office?

How are cervical polyps removed? The removal of a polyp is called a polypectomy. This typically happens in your providers office during a pelvic exam. Your healthcare provider may perform the surgery in a surgical center or operating room with anesthesia (if the polyp is large).

What is the procedure code for cervical polyp removal in the office?

Report code 57500 for an excision of a cervical polyp or Nabothian cyst.

Consent for Cervical Polyp Removal - shifa101 - The Shifa Clinic 2026

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