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Implant Removal Consent Form

The implant removal consent form is a document that is used by medical professionals to obtain consent from a patient for the removal of an implant. The form will typically include information about the risks and benefits of the procedure, as well as the potential complications that may occur. It is important that the patient understands all of the information on the form before signing it.

Time to complete

2 minutes

Eligibility

In order to fill Implant Removal Consent Form, the person must be above 18 years of age. The guardian or parent of a minor person will have to fill the form on his/her behalf.

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Questions for Implant Removal Consent Form

1.

Patient Name

The answer should be a text input.
2.

Doctor's Name

The answer should be a signature.
3.

Patient's Address

The answer should be a text input.
4.

Patient's Email

The answer should be a text input.
5.

Patient's Phone number

The answer should be a phone number.
6.

Emergency Contact number

The answer should be a phone number.
7.

I acknowledge that I have been informed of the risks, benefits, and alternatives to having my implant removed. I understand that there are risks involved with any surgical procedure, and I understand that no guarantees have been made to me regarding the results of this procedure. I hereby give my consent to my doctor to proceed with the removal of my implant.

The answer should be a single choice:
  1. I Agree
  2. I Disagree
8.

Patient’s Signature

The answer should be a signature.
9.

Date

The answer should be a text input.

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Here are some FAQs and additional information
on Implant Removal Consent Form

Can I get an implant removed before the expiration date?

Yes. There are no contraindications for having an expired implant removed.

How long does it take to go back to normal after implant removal?

You should feel completely normal after getting your implant taken out. Your arm may feel tender or swollen around where the implant was for a few days. It may look bruised for a week or two.

What are the side effects after implant removal?

Your arm may swell a little. There could be some bruising in the area that might last a couple weeks. But generally, you should feel fine after they remove your implant. Any side effects that you had with Nexplanon -- like weight gain, headache, acne, and mood swings might ease once the implant is gone.

How long after implant removal does bleeding stop?

Your bleeding pattern may change at any time. This usually improves with time but may take 6 – 9 months to settle.

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