Patient consent form

A patient consent form is a legal contract between the patient and healthcare provider.  It helps formalize the relationship between the parties involved, provides assurance of informed consent about medical treatment, and protects both parties in case of litigation relating to medical treatment. This document should be signed by the patient, allowing the clinician to provide services, but it does not obligate them to do so.  The signature may take place electronically (for example via a digital tablet) or this may be done in writing on paper.

2 minutes to complete


If you are 18 years of age or above, you are eligible to fill the Patient consent form.


Questions for Patient consent form



Name of the patient

The answer should be a text input.

Name of the Guardian

 (If patient not signing this form)

The answer should be a text input.

Relationship to patient

 (If patient not signing this form)

The answer should be a single choice:
  1. Father
  2. Mother
  3. Sibling
  4. Child
  5. Friend
  6. Other

I give my consent for the Material aboutme/the patient

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

I confirm that I

The answer should be a multiple choice:
  1. have seen the photo, image, text or other material about me/the patient
  2. have read the report to be submitted
  3. am legally entitled to give this consent

Signature of the patient

The answer should be a signature.

Signature of the guardian

(If patient not signing this form)

The answer should be a signature.

Forms Similar to Patient consent form

  • Patient Consent Form for Treatment
  • Patient Consent Form for Surgery
  • Patient Consent Form for Clinical Trials
  • Patient Consent Form for Psychotherapy
  • Patient Consent Form for Research Studies

Here are some FAQs and additional information
Patient consent form

What is the Patient Consent form?

A document with important information about a medical procedure or treatment, a clinical trial, or genetic testing. It also includes information on possible risks and benefits. If a person chooses to take part in the treatment, or testing, he or she signs the form to give official consent.

Why is the Consent form important?

When barring a physical examination, informed consent is necessary for every medical examination and surgical procedure, which should be obtained in or in the presence of a disinterested party. Further, if any extension of the procedure is required which is not covered, fresh consent should be insisted.

What is Informed Consent?

As new medical products are being developed, no one knows for sure how well they will work, or what risks they will find. Clinical trials are used to answer questions such as, whether the new product is safe? how should the product be used? etc.

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