Platelet Rich Fibrin (PRF) Information & Consent Form

Diagnosis: My surgeon has suggested the use of my own blood to improve the post-operative healing process. I may have several vials of blood drawn to make Platelet Rich Fibrin.

Recommended treatment: The use of the PRF component of my own blood. My blood will be placed in a centrifuge to concentrate the platelets. This will activate the platelets (make them release growth factors). All blood drawing materials, needles, and centrifuge processing containers are sterile and single use. 

Expected benefits: The platelets contain growth factors that help stimulate bone and soft tissue healing. 

Primary risks and complications: Bruising at blood withdrawal location.

Alternatives to suggestive treatment: No use of PRF.

No warranty or guarantee: It is understood that although good results are expected, they cannot be and are not implied, guaranteed, or warrantable. There is also no guarantee against unsatisfactory or failed results.

PATIENT CONSENT:

By providing my signature, I certify that I understand the recommended treatment, and I have had all of my questions answered. I have not been offered any guarantees.

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Clinical Information

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