Free Consent Letter Template
Consent Letter
October 1, 2050
Dr. Carl Carter
Genesis Medical Clinic
456 Health Ave
Anytown, USA 12345
Dear Dr. Carter,
I, [Your Name], hereby grant my consent to Genesis Medical Clinic to proceed with the recommended medical treatment, specifically for a minor surgical procedure to remove a skin lesion on my left arm. I understand that the procedure involves local anesthesia, excision of the lesion, and possible sutures, followed by aftercare instructions. The potential risks, including infection, scarring, or minor bleeding, have been explained to me.
I acknowledge that this consent is given voluntarily and with full awareness of the details involved. Should I wish to withdraw my consent, I will provide written notification to your office.
Thank you for your time and care.
Sincerely,
[Your Name]
[Your Email]
