Medical Consent Form Template

An easy-to-read medical consent form in PDF format for use in simple medical or surgical procedures for adults or children.

Jamie Frew
Jamie Frew
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What is a Medical Consent Form?

Ensuring your patients provide informed consent for any proposed tests or procedures is a crucial part of maintaining ethical and .

Informed consent means that the clinician has informed the patient of the risks and benefits of the procedure they are consenting to. This means they have been given a balanced and unbiased view of the procedure, and are aware of the potential negative side effects or complications they risk by consenting.

A medical consent form, or a signed by their legal guardian, is a legal document to declare in writing that the patient or their guardian has been informed of the likely risks and benefits of undergoing this procedure and that they wish to go ahead.

A medical consent form needs to include a few things. These include the patient or their representative’s name and signature, the date, the procedure or test for which they are consenting, and any other important details like the practitioner’s name or the relevant hospital department.

Printable Medical Consent Form Template

Check out these Medical Consent Form templates to improve your medical intake process and HIPAA compliance.

How to Use this Medical Consent Form

The first step to obtaining informed consent is initiating a discussion of the potential risks and benefits of the procedure in question. For example, if the patient is to be treated with radiation, they should be informed of the known short-term and long-term side effects as well as the potential benefit of shrinking their tumor. The patient should be able to ask any questions they have regarding the procedure as part of this discussion.

Once the patient or their legal guardian is satisfied they understand the potential risks and benefits of the procedure, they can begin the medical consent form.

1. Fill in the Patient Information

The first step is to fill in the patient's name, the date, and identifying information such as date of birth, gender, and identifying number if used.

2. Fill in the referring physician section

This section includes a space for the name of the referring physician, the recommended treatment/procedure, the patient’s condition, and the discussed risks and complications. The clinician obtaining the consent should then fill in their name, designation, and signature at the bottom of this section.

3. Patient to read through the form and ensure they understand what they are signing.

The patient should read the Authorization and Consent section of the form carefully and make sure they agree with each of the statements.

4. Patient and/or representative to sign 

If they are happy to proceed, the patient and/or their representative should sign the medical consent form and fill in the date. 

5. Store the record securely

The signed medical consent form is a very important legal document that you are legally required to store securely. This document may need to be accessed by other members of your patient’s care team in the future, so it should also be stored somewhere it can be easily accessed by others who may need it.

Medical Consent Form Example

This consent form includes a lot of details and information, so to help you understand what belongs where- we have produced a completed example. This example involves a patient consenting to a sentinel lymph node biopsy.

Check out and download the Medical Consent Form Example here:

Medical Consent Form Example

Who Can Use this Medical Consent Form?

Informed consent can only be given by adults capable of understanding and weighing the risks and benefits of the procedure, these people are often termed “competent adults”.

In most states, children under 18 years of age will need their legal guardian to sign the medical consent form on their behalf but this may vary for emancipated minors, married minors, or depending on your country or state’s laws.

In addition to being an adult, the person consenting must be considered sufficiently competent to understand the risks as well as potential benefits of the procedure, therefore a person with a mental impairment that makes it impossible for them to understand what they are signing may not be able to sign for themselves despite being over 18 years of age. In this case, someone with power of attorney for the patient, a conservator, or a court-appointed guardian may sign on their behalf.

Why is this Template Useful for Medical Professionals?

There are lots of things to consider when ensuring your patient is well-informed. Are they proficient enough in English to understand what they are consenting to? Do they agree for healthcare students to be present?

Thankfully, our medical consent form template includes spaces for all of these considerations and more, such as if the patient has had an opportunity to ask questions, or if they consent to the disposal of tissue for diagnostic purposes. 

Having a template that sets out these things for you in an easy-to-read way is an invaluable resource for practitioners, saving them time and ensuring they have covered all the relevant points when obtaining informed consent.

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Why Use Carepatron for Medical Practitioners?

Once your patient has completed the medical consent form, your job isn’t done yet! This form needs to be securely stored somewhere it can be accessed by other members of your patient’s care team. Using an electronic health record system like Carepatron ensures your important patient documents, such as their medical consent forms, are securely stored in a HIPAA-compliant way.

As well as this medical consent form template, Carepatron has a vast community library of other useful clinical templates ready for you to start using in your medical practice. 

On top of secure patient record storage, Carepatron offers so much more for medical practitioners. Dictate your notes directly into Carepatron using our smart speech-to-text software, manage your patients’ appointment scheduling from your Carepatron calendar and even schedule and conduct telehealth sessions right from Carepatron.

Carepatron truly offers a seamlessly integrated practice management experience, and everything within the Carepatron software has been designed to be intuitive to use and to save you time.

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If my patient signs this form, am I covered if anything goes wrong?
If my patient signs this form, am I covered if anything goes wrong?

Commonly asked questions

If my patient signs this form, am I covered if anything goes wrong?

Not necessarily. Your patient should only sign this form after they have had a discussion with their practitioner about the risks and benefits of the procedure and any questions they have. For example, if the patient agrees to radiation treatment of their mouth but is not informed that a side effect of this treatment is impaired saliva production- even if the patient signed the form, they were not fully informed, and therefore the practitioner could still be liable for a medical malpractice suit.

Can children sign their own medical consent forms?

In most countries and states, children under the age of 18 cannot give informed consent themselves. As such, a competent, adult, legal guardian must sign the medical consent form on their behalf.

What are the 3 required criteria for valid informed consent?

In order for the informed consent to be valid, certain criteria need to be fulfilled. Although these may differ depending on the country or law you reside in, the USA requires the following 3 aspects to be fulfilled: disclosure of information, competency of the patient (or representative where relevant), and the voluntary nature of the consent.

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