Background: Written informed consent is a fundamental ethical and legal requirement in surgical practice, intended to safeguard patient autonomy and promote shared decision-making. Despite its universal implementation, concerns remain regarding patients’ understanding of the consent process and the adequacy of information disclosed. Objective: This study aimed to assess patients’ knowledge, attitudes, and practices related to the informed consent process before elective surgical procedures.  Materials and Methods: A cross-sectional, questionnaire-based study was conducted in March 2024 among adult inpatients who underwent elective surgery at Sree Gokulam Medical College and Research Foundation, Kerala, India. A total of 150 patients were selected using simple random sampling and interviewed on the second postoperative day. A validated structured questionnaire was used to evaluate patient awareness of essential components of informed consent, including diagnosis, nature of surgery, risks, benefits, alternative treatment options, and the right to refuse treatment. The quality and completeness of written consent forms were assessed using a standardised observation checklist. Data were analysed using SPSS version 29 and expressed as frequencies and percentages. Results: All participants (100%) reported having signed a written informed consent form. While all patients were informed about their diagnosis and the nature of the surgical procedure, only 84.6% were aware of the expected benefits, and 76.7% understood the consequences of declining surgery. Information regarding surgical risks was provided to 92% of patients; however, 75% desired further clarification. Only 61.4% reported being informed about alternative treatment options. Although 92% felt they had adequate time to understand the consent form, 7.3% perceived the explanation as unclear. Evaluation of consent documents revealed omissions, particularly the absence of explicit statements regarding alternative treatments and patients’ rights to refuse or withdraw consent. Conclusion: Although the existing informed consent process satisfies ethical and legal requirements for most patients, important gaps persist, especially in communicating alternative treatment options and patient rights. Enhancing the clarity, completeness, and patient-centred nature of the informed consent dialogue is essential to ensure genuine patient autonomy and informed decision-making in surgical care.