Get Consent Form: Intratympanic Injections

Filling out the Consent Form for Intratympanic Injections is an important step in ensuring that you fully understand the procedure and its associated risks. This guide will provide clear, step-by-step instructions to help you navigate the online form with ease.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the Consent Form: Intratympanic Injections and open it in your digital environment.
2. Begin by entering the date at the top of the form. This should reflect the current date or the date of your appointment.
3. Fill in your full name in the 'Patient Name' field, ensuring that it matches your identification documents.
4. Provide your account number in the designated field. This number is typically assigned by your healthcare provider.
5. Enter your date of birth (DOB) in the appropriate format. Be sure to verify the accuracy of this information.
6. Select the side for the injection by marking either the box for 'RIGHT' or 'LEFT' as instructed.
7. Review the list of risks and complications associated with the procedure carefully. Acknowledge understanding these by reading through all points listed.
8. At the bottom of the form, sign where indicated to confirm you have discussed your questions with your physician and that you understand the procedure and its risks. Also, provide the date of your signature.
9. Have your healthcare provider or representative also sign and date the form in the respective fields.

Complete your Consent Form: Intratympanic Injections online today for a smooth procedural experience.