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Minor Procedure Consent Form Mobile App

The Minor Procedure Consent Form mobile app allows hospitals, clinics and physicians to get patient consent for minor procedures performed in the office as an outpatient operation. The app captures patient’s signature as well as a witnesses’. The details in the consent for can be customized to your current consent forms wordage. GoCanvas apps are great for collecting real-time information critical to your business or personal productivity.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Minor Procedure Consent Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Provider:

  • Ico date

    Date:

  • Ico textbox

    Patient:

  • Ico date

    DOB:

  • Ico integer

    Age:

  • Ico textbox

    I,

  • Ico textbox

    authorize Dr.

  • Ico statictext

    to perform the following office operation / procedure under local anesthesia:

  • Ico statictext

    Alternatives have been explained to me and I understand that any operation/procedure involves som...

  • Ico statictext

    The more common risks include:

  • Ico statictext

    Infection

  • Ico statictext

    Bleeding

  • Ico statictext

    Scarring

  • Ico statictext

    Incomplete removal

  • Ico statictext

    Nerve injury

  • Ico statictext

    Nerve injury

  • Ico statictext

    I have read and understand this consent form, and my questions have been answered.

  • Ico signature

    Patient/Responsible Party

  • Ico date

    Date

  • Ico signature

    Witness

  • Ico date

    Date

  • Ico statictext

    PHYSICIAN DECLARATION:

  • Ico statictext

    I have explained this operation/procedure, risks, alternatives, and expectations to the patient a...

  • Ico signature

    Physician's signature

  • Ico date

    Date

  • ...and More!

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More Information


  • Creator: Team GoCanvas
  • Language: English
  • Country: United States of America
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