2 minutes
A sterilization consent form can be filled by men above the age of 18 years and women above the age of 21 years.
Patient Full Name
Gender
Date of Birth
Phone number
Address
Emergency Contact number
I hereby consent to the sterilization procedure and understand that this consent is given in full knowledge of the possible consequences, which may include, but are not limited to, the following:-Pain, Bleeding, Infection, Reactions to anesthesia,Death.
Signing Date
Patient signature