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Termo de Consentimento


This term clarifies to the client all the possible complications, giving authorization to the physician and thus allowing the accomplishment of the clinical and surgical procedures, with the objective of a better result in the treatment.

I, ____________________________________________________________________ CPF _________________________ I authorize Dr. Isaac Rocha Furtado, doctor 5243 and his team to perform the following treatment (s) on my person: ___________________________________________________________________________________________________________ _________________________________________________________________________.

I further authorize the performance of any and all clinical or surgical procedures that are judged by him and / or his or her team as necessary to obtain better results in the above-described clinical or surgical treatment (s) (S), as well as the requisition and application of any and all necessary investigative, laboratorial and therapeutic resources, at the discretion of Dr. Isaac Rocha Furtado and / or his team, for the safer and better results in that treatment ( S), or to clarify any complications or complications. This authorization extends to other physician (s) requested by Dr. Isaac Rocha Furtado and / or his team to participate in the conduct of such treatment (s) or research (s).

In order to confirm and reinforce this authorization, I declare that I have previously received from Dr. Isaac Rocha Furtado all the information about the treatment (s) to which I will be submitted and that they have been fully understood. I also declare that I have been personally
Regarding all the pre and post-operative care that should be followed, as well as the complications and intercurrences that may occur in this treatment (s). (Bruises), bleeding (bleeding), local or general infections (septicemias), necrosis (death) of tissues, dehiscences (ruptures) of sutures or scars, asymmetries, irregularities Hypertrophic scars, keloid and or unsightly scars, apparent or darkened scars, neuro-muscular changes, vascular problems, thromboses, embolisms, anesthetic accidents, minor or major allergic reactions (anaphylactic shock). Other risks inherent to any invasive treatment, and death. I am well informed and aware that the final result of the treatment depends not only on the work of the doctor and his staff, but also on my personal care and above all on the unpredictable reactions of my body.

I am also well aware that smoking (use of cigarettes, tobacco in any form) and drugs can cause local or general complications, more or less serious.

I am well aware that all safety measures available at the hospital or clinic where my treatment is performed will be taken with all the technical and personal resources of the surgeon and / or his or her team in order to minimize such risks and
Others not specifically mentioned above, as well as the search for the best possible result for the proposed treatment (s).

To be truth, I sign this document for all legal purposes.

Fortaleza, ________ of ___________________ of __________.

Customer or Responsible