1. Interpreter Declaration: Required when the patient's primary language is not English, including interpreter's certification

2. Guardian Consent: Required when the patient is a minor or lacks capacity to consent

3. Experimental Treatment: Additional disclaimers and acknowledgments for experimental or non-standard treatments

4. Photography Consent: Permission for medical photography or recording for documentation/teaching purposes

5. Medicare/Insurance: Declarations regarding insurance coverage and payment responsibilities

6. Specific Contraindications: Patient's confirmation of absence of specific contraindications to treatment

1. Schedule A - Procedure Details: Detailed description of the medical procedure or treatment

2. Schedule B - Specific Risks: Comprehensive list of potential risks and complications

3. Schedule C - Pre/Post Procedure Instructions: Detailed instructions for before and after the procedure

4. Appendix 1 - Medical History Form: Patient's relevant medical history and current medications

5. Appendix 2 - Emergency Contacts: List of emergency contacts and their details

6. Appendix 3 - Supporting Medical Documentation: Any relevant test results or medical reports