Consent form:

For every patient : Summary of Consent form, to be signed at least 15 days before the procedure :

The main risks and complications of any operation are (this list is not complete):

infection, seroma (= a fluid collection), nerve damage (motor or sensitive ) (e.g. insensitivity of the wound, lesion of the facial nerve , … ) ,bruising, pain, hematoma (=bleeding), bad (stretched / thick / red/ raised / uneven / puckered ) scars, wound breakdown, delayed wound healing, allergic reactions, deep venous thrombosis of the legs, contour irregularity , asymmetry, implant failure , overcorrection, undercorrection, recurrence of sagging after lifting, result not matching expectations, …..

It is recommended to inform your GP / family doctor ( and your next of kin ) beforehand and discuss your medication with him.
The patient should 18 years old or older. For minor patients : the consent of the parents is necessary.
In case of urgent follow-up treatment or secondary , complementary procedures only can be done in Belgium.
Pre- and postoperative pictures will be taken and stored in the medical file.
The patient understands this operation is an elective cosmetic procedure and hereby acknowledge the following :
That this procedure is performed for cosmetic reasons and because of this, the results can only be assessed subjectively. Therefore, I understand that while I have been advised as to the probable result, this should in no way be interpreted as a guarantee. No explicit guarantees have been made to me concerning the results of this procedure. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.
This contract shall be governed by the laws of Belgium. Conflicts or claims of contractual and/or extra-contractual nature about any aspect of the provided care, treatment or conduct shall be governed by the laws of Belgium. In case of conflict or claim of contractual and/or extra-contractual nature about any aspect of the care, treatment or conduct only the Belgian courts of East Flanders section Dendermonde / Antwerpen and the Belgian equivalent of the general medical council/GMC (‘ordre des medecins / orde van geneesheren’ in Belgium) are competent
A package contract for travel and hotel has never been offered by the clinic or surgeon. The patient must book his/her travel and hotel independantly, having a free choice of how and where to book.
If the result is not matching the expectations : This can happen after any type of cosmetic surgery.

Additional procedure : in the event of any additional tuck-up surgery taking place for whatever reason then although the surgeons fee is waived in these circumstances, the patient will be responsible for travel and hotel costs and any anaesthesiologist and theatre facility fee ( see above). The fees charged for the current procedure do not include any potential future costs for additional procedures that the patient elects to have or require in order to revise, optimize, or complete his outcome

Consent form anaesthesia:

I acknowledge that the anaesthetist or his nurse has reviewed the proposed anaesthetic with me and answered my questions. I request the use of anaesthetics for the relief and protection from pain during the planned and additional procedures. I realise the anaesthesia may have to be changed possibly without explanation to me. I understand that side-effects and complications may occasionally result, such as

drug reactions(e.g. allergy , local anaesthetic toxicity , ….),
respiratory ( airway blockage , lung and heart problems , like arrythmia , …. ) ,
recovery problems ( low oxygen saturation in the blood , confusion, dizziness, muscle aching, nausea and memory loss, cognitive impairment, fatigue, ….)
and although extremely unlikely, death(1:250,000).
If an oral or nasal tube has been used : injury and pain at : throat, vocal cords, teeth.
Due to immobilization on the table : blood clots in the legs ( which may block the lungs …. Thrombosis / embolism)
Due to positioning on the table : pressure on nerves ( esp arms ( elbow nerve ) and legs , shoulder joints, buttock muscles ( sores ) , neck pain ( esp if already if stiff neck beforehand )
Malignant hyperthermia ( very rare condition where the body is overheating )

You must inform the anaesthetist regarding any previous dental work or loose teeth, any heart or lung problems, problems in neck , back or shoulders, and problems related to anesthesia of family members, so that he can be extra careful.

Complaint mediation

If the patient is not satisfied with the treatment, they can initially contact the treating physician himself, preferably by email ( patientcoordinator@o2clinic.be ) and / or the closest colleague – physician in the Singelberg Clinic. If this is insufficient, then the patient is referred to a third doctor, independent of the O2 Clinic, for mediation.

Mediation service (patients' rights)

What is hospital mediation?

Mediation provides a forum for dialogue between a patient and a carer in the event of conflict or misunderstanding, with the aim of encouraging the parties to find an amicable solution. The service is competent to deal with complaints relating to patients' rights under the Law of 22 August 2002. The presence of a mediator is a legal obligation in Belgian hospitals.

What is the role of the mediator?

The mediator is a person to whom patients can appeal when they feel that one of their rights has not been respected. The mediator listens, informs, helps the parties find a solution and provides a forum for dialogue. Their role is neutral, independent and impartial. If attempts to re-establish communication and dialogue fail, the mediator informs patients of the alternatives available to them. The mediator makes recommendations to the institution to prevent any recurrence of the failings that could give rise to a complaint.

When should I contact the mediation service?

If you feel that one of your rights has been infringed, please :

First of all, tell the person concerned (doctor, nurse, head nurse, etc.) to discuss the matter. Very often, professionals appreciate this kind of approach and may be able to solve the problem immediately: everyone may then be more satisfied.
If this approach does not meet your expectations, you can contact the Mediation Service to express your dissatisfaction and make a complaint.
If you have a suggestion for improvement or would like to congratulate a team.

How to contact the mediation service?

Via email

by post: ......................
by telephone: during regular working hours : ........................
By appointment: make your request using the online form or by telephone during the telephone helpline.

What if the mediator is not helpful ?

The mediator is not a judge: he or she does not have a sanctioning role, and the power he or she has depends on what the two parties are willing to give to him or her.

Not all problems relating to patient care fall within the mediator's scope. Here are some examples of situations and who to contact:

Agreement with a general hospital

Dr Oelbrandt, one of the surgeons working at O2 Clinic, has a contract with the general hospital of Bornem ( www.azr.be ) and has admission rights for secondary transport of patients should this be necessary.