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               Ingrown Toenail Procedure Consent 
  
  
  
  
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               Physician 
  
  
  
  
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               Procedure 
  
  
  
  
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               Phenol 
  
  
  
  
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               Nail Border 
  
  
  
  
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               Toe 
  
  
  • • •
  
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               Procedure Description 
  
  
  
  
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               Risks 
  
  
  
  
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               Guarantees 
  
  
  
  
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               Post-op Instructions 
  
  
  
  
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               Patient/Parent/Guardian Signature 
  
  
  
  
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               Signature 
  
  
  
  
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               Witness Signature 
  
  
  
  
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               Signature 
  
  
  
  
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