4. I understand that although the doctor has sent me an information sheet and explained to me the most common side effects of this treatment, there may be other side effects of this treatment.
I understand that I may decide to stop taking the medication at any time and may not be compelled to take this medication. I also understand that I should first discuss any changes with the doctor to review risks of discontinuation.
I also understand that although the doctor believes that this medication will help me, there is no guarantee as to the results that may be expected.
The above information has been explained and any questions I have pertaining to this medication have been answered to my satisfaction. I also understand that I may have other questions later and I am free to ask at that time.
On this basis I give consent and request treatment with the above medication at such dosage and intervals as deemed advisable.