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Form Approved: OMB No. 0937-0166 Expiration date: 12/31/2015 CONSENT FOR STERILIZATION NOTICE: YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY

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What is consent for sterilization?

Consent for sterilization is a legal document signed by a patient to give permission for a sterilization procedure.

Who is required to file consent for sterilization?

Any individual seeking sterilization must file consent for sterilization.

How to fill out consent for sterilization?

Consent for sterilization is typically filled out by the healthcare provider performing the procedure and signed by the patient.

What is the purpose of consent for sterilization?

The purpose of consent for sterilization is to ensure that the patient has made an informed decision to undergo a permanent sterilization procedure.

What information must be reported on consent for sterilization?

Consent for sterilization must include information about the procedure, risks, alternatives, and confirmation of voluntary consent.

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