Informed consent for hysterectomy (total, subtotal, or radical), covering surgical approach options, indication, benefits, risks including loss of fertility, alternatives, and postoperative expectations.
The Hysterectomy 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, hysterectomy, gynecologic surgery, 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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# Hysterectomy 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:** ___________ --- ## NOTICE: LOSS OF FERTILITY **Hysterectomy involves the surgical removal of the uterus. After this procedure, you will no longer be able to become pregnant or carry a pregnancy. This is permanent. You should consider this decision carefully if you have any desire for future pregnancy.** --- ## 1. Procedure I, the undersigned patient, consent to hysterectomy performed by my healthcare provider. **Extent of surgery planned:** ___________ **Ovaries and tubes:** ___________ **Surgical approach:** ___________ Hysterectomy removes the uterus (and the cervix if total). The procedure is performed in the operating room under general or regional anesthesia. The surgical approach (abdominal, vaginal, laparoscopic, or robotic) is selected based on uterine size, pathology, prior surgeries, body habitus, and surgical expertise. --- ## 2. Indication **Clinical indication (e.g., uterine fibroids, endometriosis, adenomyosis, pelvic organ prolapse, abnormal uterine bleeding, gynecologic malignancy, obstetric hemorrhage):** ___________