Objective: By providing junior members of medical staff with appropriate guidelines one can achieve an improved standard of informed consent for tonsillectomy, than is provided at present. Design: A prospective study of 138 consecutive patients. Setting: District General Hospital. Participants: A total of 138 patients undergoing routine tonsillectomy split into two groups. Group A (n = 87), the conventional group, gave consent in our unit's standard manner to various grades of doctors by using a hospital general surgical consent form. Most gave their consent as outpatients, while some consented on admission. Group B (n = 51), the structured consent group, gave their consent in pre-admission clinic, to an SHO using a standardized tonsillectomy consent form and a structured interview technique. Main outcome measures: A preoperative questionnaire regarding the knowledge of tonsillectomy. Results: Improvement of the awareness of the risks involved with tonsillectomy was achieved by the structured consent Group B; 82% of Group A were aware of postoperative pain compared with 94% of group B (P = 0.04); 63% of group A were aware of infection compared with 82% of group B (P = 0.02); 100% of group B had read the consent form before signing compared with 80% of group A (P < 0.01). There was no statistical difference in the awareness of postoperative haemorrhage (91 versus 98%, P = 0.15). Conclusion: By providing junior medical staff with guidelines, senior staff retain responsibility for consent while improving the standard of informed consent for tonsillectomy.