Consent to Treatment Form

This document outlines a Patient Consent to Medical Treatment form. It captures details about the patient (name, DOB, contact information), the treatment/procedure (name of physician, description, risks, benefits, alternatives), and patient acknowledgments. The form emphasizes the patient's right to refuse or withdraw consent at any time. It concludes with sections for signatures from the patient (or representative) and the healthcare provider, along with an acknowledgment of receipt. The form also includes contact information for questions and a privacy notice.

How It Works

This template has been set up as a Word document (.docx).

After purchase, you'll get access to the Word template immediately.

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FAQs

Google Docs version?

This template can easily be uploaded to use in Google Docs (via your Google Drive page).

Share with team

This purchase is for a single license for you to use with your team. If you want to share with additional teams, divisions or people from other companies, please get in touch (to discuss the extra licenses).

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Disclaimer: This template has been researched and compiled to be used as a starter template for your business. Ensure your final template meets relevant legal regulations before using it.