undefined
HomeAll templatesconsent formsmedical consent form

Medical Consent Form

A medical consent form is a document that is used to give another person permission to provide medical treatment to you or your minor child. This form is also sometimes referred to as a medical release form or a healthcare authorization form.

2 minutes to complete

Eligibility

The medical consent form is basically filled by the parents or guardians of the child who is going to get the medical treatment. The parents or guardians can give permission for a single treatment or for all the treatments that the child may require in the future.

undefined

Questions for Medical Consent Form

Questions

1.

Full name

The answer should be a text input.
2.

Date of birth

The answer should be a date input.
3.

Gender

The answer should be a single choice:
  1. Male
  2. Female
4.

Contact Number

The answer should be a phone number.
5.

Medicare number

The answer should be a text input.
6.

Health fund details

The answer should be a text input.
7.

Emergency contact details

The answer should be a text input.
8.

I understand that I am responsible for the payment of all medical services rendered.

The answer should be a single choice:
  1. I Agree
  2. I Disagree
9.

I hereby release the medical facility and its staff from any and all liability that may arise from the provision of medical care and treatment to me or my child. I understand that this consent form will remain valid for a period of one year from the date of signing. After this time a new form will need to be completed.

The answer should be a single choice:
  1. I Agree
  2. I Disagree
10.

Signature

The answer should be a signature.
11.

Date

The answer should be a date input.

Forms Similar to Medical Consent Form

  • General consent form
  • Treatment consent form
  • Surgery consent form
  • Anesthesia consent form
  • Blood transfusion consent form
  • Radiology consent form
  • Biopsy consent form
  • MRI consent form
  • PET scan consent form
  • CT scan consent form

Here are some FAQs and additional information
on Medical Consent Form

What is a medical consent form?

A medical consent form is a document that gives a healthcare provider permission to provide medical treatment to a patient. The form typically includes the patient's name, date of birth, and contact information, as well as the healthcare provider's name and contact information. The form may also include the patient's medical history and current medications. The form should also include a section for the patient to sign and date, giving their permission for the healthcare provider to provide medical treatment.

What information should be included on a medical consent form?

A medical consent form should include the patient's name, date of birth, and contact information, as well as the healthcare provider's name and contact information. The form may also include the patient's medical history and current medications. The form should also include a section for the patient to sign and date, giving their permission for the healthcare provider to provide medical treatment.

Do medical consent forms need to be notarized?

No, medical consent forms do not need to be notarized. However, they should be signed by the patient and the healthcare provider, and dated.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Medical Consent Form

1000+ Templates, 50+ Categories

Explore more
undefined
Experiment consent form
An experiment consent form is a type of form used in research that outlines the details of an experiment and obtains consent from participants.
undefined
Nutrition consent form
This is a nutrition consent form that can be used by nutrition clients. It includes information about nutrition counseling.
undefined
Eyelash Extension Consent Form
An Eyelash Extension Consent Form is used to document a client’s agreement to having eyelash extensions applied. This form should be completed prior to the service in order to protect both the client and the technician.
undefined
Implant Removal Consent Form
The implant removal consent form is a document that is used by medical professionals to obtain consent from a patient for the removal of an implant. The form will typically include information about the risks and benefits of the procedure, as well as the potential complications that may occur. It is important that the patient understands all of the information on the form before signing it.
undefined
Tracheostomy Consent Form
The Tracheostomy Consent Form is a legal document that protects the medical practitioner from any legal liability in case the patient suffers any complications during or after the surgical procedure. The form also requires the patient’s signature, which gives the doctor the permission to carry out the tracheostomy.
undefined
Photo Consent Form
A Photo Consent Form is a document that is used by an individual or organization to seek the consent of the individual or organization to be photographed. This form may also be used to seek the consent of an individual or organization to use the photograph for a specific purpose.
undefined
Travelling Consent Form
A travelling consent form is a document that is used to provide permission for mostly a child to travel without their parent or legal guardian. The form will typically include information about the child's destination, travel dates, and contact information for the adult responsible for the child during the trip. The form may also include space for the parent or guardian to provide any special instructions or requests.
undefined
Cataract Surgery Consent Form
Cataract surgery consent form is a document which is used by the patients who are willing to get their cataract surgery done by a certain surgeon. This form contains all the necessary information about the surgery and the patient’s consent for it. It is very important for the patient to read and understand all the information given in this form before signing it.
undefined
Psychology Consent Form
A psychology consent form is a form that is used by psychologists to obtain consent from their patients before conducting psychological research on them. This form typically contains information about the research project, the risks and benefits of participating in the research, and the patient's rights.
undefined
Ventilator Consent Form
A ventilator consent form is used when an individual is being placed on a ventilator for medical reasons. The form documents the individual's consent to the use of the ventilator and the individual's understanding of the risks and benefits associated with the use of the ventilator.
undefined
Therapy Consent Form
The Therapy Consent Form is a document that is used by a therapist to obtain consent from a patient for treatment. The form usually includes all relevant information about the treatment, including the risks and benefits. It should also explain the patient's rights and responsibilities.
undefined
Hair transplant consent form
The Hair transplant consent form is a form that is used by patients who are undergoing hair transplant surgery. This form is used to document the patient's consent to the procedure and to the use of their donor hair. The form also includes information about the risks and benefits of the procedure, as well as the patient's rights and responsibilities.
undefined
Counselling Consent Form
Counselling Consent Form is a document signed by the client and his/her counsellor which gives the counsellor the permission to provide counselling services to the client. This document also outlines the terms and conditions of the counselling relationship and the limits of confidentiality.
undefined
Background verification consent form
A background verification consent form is a document that is used by employers to obtain an individual's permission to conduct a background check. This form usually includes information about the individual's rights, the types of background checks that may be conducted, and the purpose of the background check.
undefined
Interview Consent form
An interview consent form is a document that is provided to research participants prior to conducting an interview. The form outlines the purpose of the research, the questions that will be asked, and the expected length of the interview. The form also obtains the participant's consent to be interviewed and to have the interview recorded.
undefined
Picnic consent form
A picnic consent form is a legal document that gives permission for a child to participate in a picnic or other outdoor activity. The form should be signed by a parent or guardian, and it should include a list of any activities that will be taking place during the picnic.
undefined
Sterilization Consent Form
A sterilization consent form is an important legal document that must be completed and signed by a patient who is about to undergo a surgical procedure to have their reproductive organs removed. The form outlines the risks, benefits, and alternatives to the procedure and must be signed by the patient in order to give their informed consent.
undefined
Amputation Consent Form
The Amputation Consent Form is a document that is used to give informed consent for an amputation procedure. The form will typically list the risks and benefits of the procedure, as well as the potential complications. It is important to read and understand the form before signing it.
undefined
Implant Consent Form
The Implant Consent Form is a document that is used when someone is considering having an implant procedure done. This form will help to ensure that the patient is fully informed about the risks and benefits associated with the procedure. It is important to read and understand this form completely before signing it.
undefined
Dental Treatment Consent form
Dental treatment consent form is a type of form which is used by the dental clinics to know the consent of the patients regarding the dental treatment. This form is very important for the dental clinics as it helps them to know whether the patient has agreed for the treatment or not. This form also includes the details of the treatment which will be given to the patient.
undefined
Blood Transfusion Consent Form
Blood transfusion consent form is used by patients who need to receive blood transfusions. This form gives the patient's permission for the doctors to transfuse blood into their body. The form also includes information about the risks and benefits of transfusions, as well as the patient's rights.
undefined
Medical Consent Form
A medical consent form is a document that is used to give another person permission to provide medical treatment to you or your minor child. This form is also sometimes referred to as a medical release form or a healthcare authorization form.

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE