Informed consent for colposcopic examination with or without loop electrosurgical excision procedure (LEEP) for evaluation and treatment of abnormal cervical cells.
The Colposcopy & LEEP Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, obgyn, colposcopy, leep, cervical dysplasia, reproductive health. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Colposcopy & LEEP Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ **Ordering Provider:** ___________ **Planned Procedure Date:** ___________ --- ## 1. Procedure I, the undersigned patient, consent to the following procedure(s): **Procedure(s) planned:** ___________ ### Colposcopy Colposcopy is a magnified examination of the cervix using an instrument called a colposcope. Acetic acid (vinegar solution) and/or Lugol's iodine solution are applied to the cervix to highlight abnormal areas. If suspicious tissue is identified, one or more small biopsies (cervical punch biopsies) and/or an endocervical curettage (ECC) sample may be taken. ### Loop Electrosurgical Excision Procedure (LEEP) LEEP uses a thin wire loop charged with electrical current to excise (cut away) abnormal tissue from the cervix. The procedure removes the transformation zone and a small cone of tissue. The excised specimen is sent to pathology for evaluation. LEEP takes approximately 10–20 minutes in the office under local anesthetic. Steps include: 1. A speculum is placed and the cervix is visualized. 2. Local anesthetic is injected into the cervix (cervical block). 3. The wire loop removes the abnormal tissue layer. 4. A ball electrode may be used to achieve hemostasis (bleeding control). 5. Monsel's solution or silver nitrate is applied to the treated area. ---