Phone: 837-769-3603-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the 'PATIENT NAME' field. This is essential for identifying your consent.
  3. Select the procedure you are consenting to by checking the appropriate box next to 'EDC or surgical excision & reconstruction' or writing in another procedure if applicable.
  4. Fill in the 'DATE' field with the date of your procedure.
  5. Complete the 'LOCATION' section with where the procedure will take place.
  6. Read through the consent statement carefully, ensuring you understand all risks and alternatives before signing.
  7. Sign and date where indicated as 'Patient Signature' and 'Date'.
  8. If required, have a witness sign and date in their respective fields.
  9. For medical personnel, answer all relevant questions regarding health history by selecting YES or NO.

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