MOF-001 · Informed Consent Form
General Examination
Informed consent prior to examination — mandatory for Health Directorate inspection
Dr. Özgür Akşan — Neurosurgery (Brain and Nerve Surgery)
General Examination — full text reading
An audio reading of the full form text below
What Is a Consent (Informed Consent) Form? What Is It For?
A consent form (formally an informed consent form) is a document that informs you about a procedure or surgery recommended to you. It explains in plain language what the procedure is, its expected benefits, possible risks, and alternative treatments if any.
Its purpose is not to frighten you, but to enable you to make the decision about your health knowingly and willingly. Giving or withholding consent to a procedure is your most natural right.
- It ensures you receive sufficient and understandable information before the procedure.
- It lets you see the benefits and risks in advance and ask your questions.
- It safeguards your right to decide freely and to withdraw your consent at any time.
You can read the form on this page, listen to it, and download it. After reading the form and having your questions answered, you give your consent by signing it at the clinic.
This information was prepared by Dr. Özgür Akşan.
EXAMINATION CONSENT FORM
Informed Consent Form
| PATIENT PROTOCOL NO | DATE |
|---|---|
| PATIENT'S NAME–SURNAME | Turkish ID (T.C. Kimlik) / Passport No |
My doctor has informed me in detail about the following matters:
- The probable causes of my illness and how it is likely to progress
- How the treatment will be carried out, its estimated duration and cost, and that a consultation with other physicians may be requested if deemed necessary
- Other diagnostic and treatment options, the benefits and risks these options entail, and their possible effects on my health
- Possible side effects and complications
- The possible benefits and risks that may arise if I refuse treatment
- The important properties of the medications to be used
- Lifestyle recommendations that are critical for my health or complementary to my treatment
- That, during the intervention(s) and/or treatment(s) planned by my doctor, situation(s) may be encountered that require additional interventions and treatments beyond those planned
- How I can access medical assistance on the same matter when needed
I have been informed about my illness and the treatment process. I have understood the information conveyed to me verbally, and I have received information on the matters I wished to learn about. I have informed my doctor that I have no further questions. Of my own free will, I give my consent to this examination.
| Name – Surname | Signature | Date | |
|---|---|---|---|
| Patient | |||
| Legal Representative / Relative <br>(Degree of relationship: ……………………) | |||
| Responsible Physician | Dr. Özgür Akşan |
- This form has been prepared based on Nöroşirürjide Aydınlatılmış Rıza Formları [Informed Consent Forms in Neurosurgery] (2025, ISBN 978-605-4149-28-5), published by the Türk Nöroşirürji Derneği (Turkish Neurosurgical Society).