The Dermatology Procedure Consent (Biopsy/Excision/Cryosurgery) 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, healthcare, dermatology, biopsy, excision, cryosurgery. 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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# Dermatology Procedure Consent (Biopsy/Excision/Cryosurgery) > **Important — not medical advice.** For use by a licensed provider; verify state scope-of-practice and informed-consent rules. **Date:** ___________ **Practice Name:** ___________ **Dermatologist / Provider:** ___________ **License Number:** ___________ **Patient Name:** ___________ ("Patient") **Date of Birth:** ___________ --- ## 1. Proposed Procedure(s) The Patient consents to the following dermatologic procedure(s) as recommended by the provider: **Primary Procedure:** ___________ **Additional Procedure(s), if any:** ___________ **Anatomical Location(s):** ___________ **Clinical Indication / Lesion Description:** ___________ **Number of Lesions to be Treated:** ___________ --- ## 2. Description of Procedures (a) **Shave Biopsy:** A superficial skin sample is removed with a blade. Leaves a shallow, typically round wound that heals by secondary intention. A small permanent mark is common. (b) **Punch Biopsy:** A circular blade removes a full-thickness skin core, usually 2–6 mm in diameter. One or two sutures may be placed. A small scar remains.