1. Interpreter Declaration: Required when the patient's primary language is not the language of the document

2. Guardian Consent: Required when the patient is a minor or legally incompetent

3. Photographic Consent: Optional section for consent to photograph or record the procedure for medical documentation

4. Insurance Details: Required when insurance coverage is relevant to the procedure

5. Religious or Cultural Considerations: Required when specific religious or cultural factors affect treatment decisions

6. Concurrent Treatment Declaration: Required when patient is undergoing other treatments that might interact

7. Pregnancy Declaration: Required for female patients of childbearing age when procedure could affect pregnancy

1. Schedule A - Detailed Procedure Description: Technical description of the medical procedure including steps, methods, and materials used

2. Schedule B - Risk Disclosure Checklist: Itemized checklist of all risks discussed with patient initials against each

3. Schedule C - Pre-Procedure Instructions: Detailed instructions for patient preparation before the procedure

4. Schedule D - Post-Procedure Care: Instructions for post-procedure care and recovery

5. Appendix 1 - Medical Terms Glossary: Simplified explanations of medical terms used in the document

6. Appendix 2 - Emergency Contact Form: Emergency contact information and medical history form