The Tubal Ligation (Sterilization) 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, tubal ligation, sterilization, contraception, 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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# Tubal Ligation (Sterilization) 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 OF PERMANENT STERILIZATION **Tubal ligation is intended to be a permanent, irreversible method of contraception. You should not choose this procedure unless you are certain that you do not want to become pregnant in the future. Reversal (tubal reanastomosis) is a complex surgery, is not always successful, and is generally not covered by insurance. Do not rely on the possibility of reversal when making this decision.** --- ## 1. Procedure I, the undersigned patient, consent to bilateral tubal ligation (surgical sterilization) performed by my healthcare provider. **Planned surgical approach:** ___________ **Planned occlusion method:** ___________ Tubal ligation works by blocking, cutting, burning, or removing the fallopian tubes so that eggs released from the ovaries cannot travel to the uterus, and sperm cannot reach the egg. The procedure is performed in the operating room under general or regional anesthesia. For **laparoscopic** sterilization: 1. A small incision is made at or near the navel; the abdomen is insufflated with carbon dioxide gas. 2. A laparoscope (camera) and instruments are inserted through one or two small incisions. 3. The fallopian tubes are identified and occluded by the chosen method. 4. Instruments are removed, gas is released, and incisions are closed. For **minilaparotomy** or **postpartum** sterilization: 1. A small transverse incision is made just above the pubic hairline (or at the navel if early postpartum).