Informed consent for tonsillectomy and/or adenoidectomy in a pediatric or adult patient. Covers procedure description, indications, risks (including post-operative bleeding and airway complications), alternatives, and post-operative care expectations. Parent/guardian signer for pediatric patients.
The Tonsillectomy / Adenoidectomy Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (parent) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, healthcare, ent, tonsillectomy, adenoidectomy, pediatric. 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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# Tonsillectomy / Adenoidectomy Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Date:** ___________ **Surgeon / Otolaryngologist:** ___________ **Facility:** ___________ **Child's Name:** ___________ ("Patient") **Child's Date of Birth:** ___________ **Parent / Legal Guardian Name:** ___________ ("Parent/Guardian") **Relationship to Patient:** ___________ **Procedure(s) Planned:** ___________ --- ## 1. Description of the Procedure (a) **Tonsillectomy** is the surgical removal of the palatine tonsils, two lymphoid tissue pads located on each side of the back of the throat. The procedure is performed under general anesthesia. Common surgical techniques include cold dissection (scalpel/scissors and ties), electrocautery, coblation (radiofrequency energy), or a harmonic scalpel. The surgeon will discuss the technique planned for this patient. (b) **Adenoidectomy** is the surgical removal of the adenoid pad, a mass of lymphoid tissue located behind the nasal cavity at the top of the throat. It is typically performed through the mouth using a curette, electrocautery, or powered microdebrider. Adenoidectomy is almost always performed under the same general anesthetic as tonsillectomy when both are indicated. (c) The operative time is typically 20–45 minutes. The procedure is most often performed as outpatient surgery, though overnight observation is sometimes required depending on patient age, weight, severity of obstructive sleep apnea, or surgeon judgment. **Planned Surgical Technique:** ___________ --- ## 2. Indications The procedure is indicated for this patient for the following reason(s): **Primary Indication(s):** ___________