Gentle Procedures Toronto
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Infant Circumcision Consent

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Patient Information

Patient Name (As indicated on Health Card)*
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  • Significant post-op bleeding (1/400)
  • Phimosis or narrowing of the shaft-skin opening over the head of the penis (1/500)
  • Buried or trapped penis in the abdomen (1/800)
  • Infection requiring antibiotics (1/1,000)
  • Meatal stenosis or narrowing of the urethra (1/1,000)
  • Sub-optimal cosmetic outcome (1/500)
  • Trauma to the head of the penis (1/40,000)
  • Injury to the urethra including urethra-cutaneous fistula (1/1,000)
  • More serious complications including death (1/1,000,000)
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    Parent/Legal Guardian Consent

    Clear Signature
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    Clear Signature
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    * You will be automatically redirected to the Electronic Communication Consent Form.