Form 3102 D

This form deals specifically with the effects of the EDEN Procedure. For the general risks associated with all forms of neuro-alterative surgery, please consult form 3102 B, attached.

By signing this form and thus consenting to the EDEN Procedure, henceforth referred to as “the procedure,” you acknowledge that you are aware of and accept the following:

The procedure’s effects on your mental faculties are permanent. Once your knowledge of your own mortality has been removed, it is impossible to restore. Furthermore, even if a procedure to restore it were to be invented, you would not be aware of what you lacked and thus would be unable to request the restoration.

While the procedure removes your knowledge of your own mortality, it will not affect your abstract knowledge of death, nor will it affect your sense of pain. Subjects generally experience no elevated risk of suicide.

Regardless of the procedure, you will die. Accordingly, any and all preparations for death must be made prior to the operation. This includes wills and testamentary documents, life insurance, and last rites of any religious nature. If you do not make these arrangements prior to the operation, the hospital bears no responsibility for your subsequent inability to complete them.

Common side effects include, but are not limited to, lethargy, depression, and reckless behavior.

If you are receiving this procedure as part of standard military training, check here        _____

If you are receiving this procedure as a benefit of a class one hazardous job, check here _____

If you are receiving this procedure for personal or recreational purposes, check here. _____

Signature: ___________________________        Date: __________

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