Hello Ethelind, welcome to Susan's!
I received one of these forms before FFS (consent to publish photos) and it was purely optional. I could have decided to reject the form or sign it, and proceed with surgery either way.
The form you are looking at is probably optional for your particular surgeon but I can't be certain - the accurate answer is with your surgeon's office. You're showing why it's good to understand what's in a form before signing it.