I authorized ABC Clinic to perform this diagnostic procedure as part of my treatment.
I understand the complications and risks that might happen as a result of this procedure. However, I still like to proceed.
I release and hold harmless ABC Clinic against any claims, damages, costs, which may occur during or after the procedure.
I understand that I need to follow the pre-care and post-care instructions given by the clinic.
By signing this consent, I confirm that I have read and understood all the information indicated in this document. I also assure you that I'm of legal age. I fully accept all responsibilities for these or any other complications that may occur during the procedure.