The Functional Endoscopic Sinus Surgery 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, healthcare, ent, fess, sinus surgery, endoscopic. 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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# Functional Endoscopic Sinus Surgery Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Date:** ___________ **Surgeon / Otolaryngologist:** ___________ **Facility:** ___________ **Patient Name:** ___________ ("Patient") **Date of Birth:** ___________ **Medical Record Number (if applicable):** ___________ **Procedure(s) Planned:** ___________ --- ## 1. Description of the Procedure (a) **Functional Endoscopic Sinus Surgery (FESS)** is a minimally invasive surgical technique performed through the nostrils using a rigid nasal endoscope. No external incisions on the face or skin are made. The surgeon uses the endoscope for direct visualization and removes diseased tissue, polyps, and bony obstructions to re-establish drainage pathways from the paranasal sinuses (maxillary, ethmoid, frontal, and/or sphenoid sinuses) into the nasal cavity. (b) The specific sinuses addressed depend on the extent of disease. The surgeon will discuss the planned scope of surgery preoperatively. CT imaging of the sinuses is used for surgical planning and may be displayed in the operating room via an image-guidance (navigation) system. (c) **Balloon sinuplasty** is a catheter-based technique that dilates the natural sinus opening using an inflatable balloon rather than tissue removal. It may be used alone or alongside conventional FESS for selected sinuses (typically frontal, maxillary, or sphenoid). (d) **Image-guided surgery (IGS/navigation):** ___________ (e) The procedure is performed under general anesthesia, typically lasting 1–3 hours depending on the extent of disease. --- ## 2. Indications FESS is recommended for this Patient for the following reason(s): **Primary Indication(s):** ___________