This document must be signed on the spot, in Budapest. Please read it carefully.

I (undersigned)  ……………………….. (patient’s name) declare that HairPalace has informed me about the planned surgical intervention.

I understand and accept that the risk associated with the surgical intervention and the post-operational period cannot be anticipated with certainty even under the conditions of the most careful treatment. I am convinced that the expected benefits outbalance the risks explained. By this decision of mine I take all responsibility for my determination concerning the surgical intervention. Prior to the surgical intervention I participated in consultations where – considering not only the above mentioned facts but also the expected duration of the surgery as well – I myself have decided the degree, areas, dimensions and the location of the intervention deemed to be necessary by me. I declare that in my decision I have considered all the above and I will keep the given medical advice and recommendations necessary for my complete recuperation.

I also declare that I have been provided with sufficient information about the details of the surgical intervention, my health conditions and the changes occurring as the consequence of the surgery with special regards to the expectable results and the process of the surgery. I further acknowledge that I have been given an opportunity to ask any questions I desired and that these questions have been answered to my complete satisfaction.

Furthermore, I declare that I have thoroughly informed the institute performing the surgery about my medical history, health status and any circumstances affecting the recovery, including any factors (such as smoking) that may contraindicate the surgical intervention. To the best of my knowledge I am not suffering from any severe diseases that would interfere with the successfulness of the treatment (e.g., diabetes mellitus, other metabolic diseases, breathing and heart issues, infectious diseases, wound healing problems, haemophilia, etc., I am not pregnant, I don’t take special medicaments, and I have no hyperaesthesia to medicaments). I understand that withholding such medical information could lead to serious surgical and post-operational complications.

Provided I obtain information about such problems, I will inform the treating/operating physician with no delay.

I have been informed that besides the general risks of surgical interventions (bleeding, swelling, local and general inflammation, infection, wound healing complaints, and the operation-related burden on the body) and other problems may be associated with the post-operational period and in addition to any other complaints arising from the intervention requested by me, such as special deformations causing primary aesthetic complaints, effusions, local change of skin colour, scars with different thickness, deformations, etc.

On having any complaints or experiencing complications, I will inform the surgery institute with no delay.

Failing to comply subsequently results in the surgery institute disclaiming all responsibility.  I have been informed that the biological reaction and its duration may vary, therefore, depending on the nature of the surgical intervention and the reacting ability of my body, the expected result and the duration of final recovery period may differ from those of the average.

I declare that I have considered all these when making my decision and I will keep all the given medical recommendations and the medical advice considered  necessary for my complete recovery such as bed-rest, relaxation, regimen, wound protection and protection against sunshine and cosmetics, appearance of indicative signs, and participation in the prescribed control examinations, etc.).

I have also been informed that the final aesthetic result achievable through the surgery (intervention) can be expected as soon as within the space of 15 months.

If there are any conditions revealed during the operation which requires counteracting to avoid life risk or if the method of surgery needs to be altered in such ways that expectedly lead to a better result, I consent and authorise the physician to perform such necessary intervention on me.

I have been informed that the physicians involved in the intervention can take only professional responsibility for their actions, as in they are required perform the intervention or have it performed in a responsible manner and to the best of their knowledge and ability and they do it by acting with the highest possible prudence and care as has been stipulated by the Health regulation, furthermore, they ensure the provision of the necessary control examination(s) and bandage change(s) at the appointed times.

I understand and agree that the professional physician possesses the required medical liability insurance policy and the operation-related financial risk-bearing is in compliance with the conditions formulated in this policy, therefore, for instance, the physician does not take any financial responsibility in the event of aesthetic complaints.

Provided a repeated operation associated with the current medical intervention is performed in another institution without the involvement or notification of the surgeon or the institution performing the current operation, all the professional liabilities of the operating physician involved in the current operation or those of the institute expire.

Accepting and understanding all the above, I give a written consent to the performing of the surgical intervention.

Hereby I declare that in the event of some unforeseen circumstances encountered in the process of the medical intervention, in the framework of which the extension or the modification of the treatment becomes necessary,

I will give my consent to such necessary expansion or modification of the procedure. I agree to the taking of photographs and preparing medical documentation about me for the purposes of medical studies and research work.