Exparel Consent Form

Exparel Consent Form
We offer Exparel for purchase to our patients who would like to have an extra nerve block. This is a non-opioid bupivacaine liposome injectable suspension that provides a significant long lasting pain control for our patients. Exparel is available for purchase at your pre-operative appointment for $350.00.
Please select one of the options below.*

I have been advised and accept.I have been advised and refuse.
Patient Name*

First NameLast Name
Patient Signature:*

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DateTime*
Patient Email:
Please complete this field if you would like a copy of your completed forms emailed to you.
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