Consent

I have discussed the potential of my baby having a tongue tie, the relevance of this, and potential options of conservativemanagement or treatment.

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I am aware of the risk of bleeding and the immediate management, which may include transfer to hospital for treatment with adrenaline, suturing and blood transfusion. Risk less than 1:2500

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My baby has had Vitamin K and there is no known history of bleeding disorders in the family or I have discussed the implications of baby having additional risk of declining or choosing oral dose.

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I am aware of the potential for infection in the wound bed. Please note: I have never seen a baby with an infection, post procedure.

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I am aware of the risk of damage to the tongue, muscles, blood vessels, nerves, salivary glands. I have never had an event where this occurred.

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I am aware my baby may be unsettled for a few days and strategies to help will be provided in the aftercare leaflet which is available in the baby's document.

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I understand that improvement after tongue-tie divisio is not guaranteed and that there is a remote possibilitythat feeding will get worse. Any improvement may take up to a few weeks to achieve.

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​I am aware that healing may create recirrence through reattachment or excessive scar formation and further surgery may be required. If this occurs I will offer a revision within a review appointment and no additional fee.will be applied. My stats are less than 1.8% of babies require further surgery.

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The procedure may not be completed if unsafe to do so. In this instance you will receive a letter to share with your GP to ask for an NHS assessment and treatment. Frenulotomy additioal fee will not be applied to invoice.

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I am aware that post division aftercare leaflet will be provided and accessible in my notes.

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The risks are clearly understood by me and I have had the opportunity to ask questions.

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​I understand that I may require follow-up support and I can access follow-up by phone, email or book a private follow-up session.

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I confirm I have legal guardianship and the authority to consent to surgery following the assessment.