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INFORMED CONSENT FOR ALLERGY TESTING AND …

A-2 08/26/2008 1 Ear, Nose and Throat of Northwest GA (706) 235-0116 INFORMED CONSENT FOR ALLERGY TESTING AND TREATMENT DO NOT SIGN THIS form UNTIL YOU HAVE READ IT AND FULLY UNDERSTAND ITS CONTENTS. PATIENT'S NAME: _____ DATE: _____ In addition to the requirements of Georgia law, the following CONSENT is also intended to improve communication with and education of patients. The following has been explained: 1. The DIAGNOSIS requiring this procedure: ALLERGIC RHINITIS. 2. The NATURE of this procedure is: HYPOSENSITIZATION.

a-2 08/26/2008 1 ear, nose and throat of northwest ga (706) 235-0116. informed consent for allergy testing and treatment . do not sign this form until you have read it and fully understand its contents.

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