Julia Smith: The Informed Consent and Request For Surgery Document contains twelve points that either Dr. Monteith or Dr. Berger will review with you in detail and each of you will sign it. The twelve points are:

1. I request either Dr. Charles Monteith or Dr. Gary Berger to perform the surgical procedures described below at Chapel Hill Tubal Reversal Center.
2. I understand the nature and purpose of the procedures.
3. I under that Dr. Monteith or Dr. Berger perform outpatient tubal reparative surgery through an incision that is above and parallel to the pubic bone. This is called a mini laparotomy incision.
4. I’m aware that surgery has potential risks and/or complications.
5. I’ve read and understand the accompanying form entitled Potential Risks Of Surgery.
6. I’m aware that IVF is an alternative to tubal reparative surgery.
7. I understand the potential benefits and risks associated with this alternative treatment of IVF.
8. I understand there is guarantee following the outcome of my tubal reversal procedure. And confirm that Dr. Berger or Dr. Monteith nor any member of the staff has given me any guarantee, warrantee or assurance regarding the outcome of the tubal reversal procedure.
9. I understand that my fallopian tubes may not be able to be repaired. And if the tubes are repaired there is no guarantee that I will be come pregnant.
10. I also understand that if I do become pregnant I have an increased risk of a tubal or ectopic pregnancy.
11. I am aware of the Early Pregnancy Monitoring Protocol recommended by Dr. Berger and Dr. Monteith.
12. I understand that unanticipated conditions may require additional or different procedures from those described.