ANNEXED CONSENT FOR LIPOSUCTION

Buenos Aires ....... 200

Patient:

In addition to the expressed in the general consent for surgical interventions I recognize that the following points have been specially explained to me:

After the operation liposuction the following can happen:

1. Echimosis in the operated zones (hips, knees, abdomen, etc) that heal spontaneously.

2. Irregularities of the contour in the operated zones, that tend to improve spontaneously in the following months, with the resolution of edema or the inflammation.

3. Increased sensitivity in the operated areas due to swelling, with spontaneous recover in a lapse of 6 months.

4. You must follow doctor's indications to avoid usual complications as infection, hematoma, seromas, etc

Name of Patient: ......................................

Passport nº: ........ ... .... .... ..

Signature: ..................................................................

Name of Accompanying Individual: ...............................

Passport nº: ....................................................

Signature: ...................................................................

Last Update : 18/03/2008