The Health Consent Form Template by WPForms is designed for all types of clinics, hospitals, and healthcare professionals who are looking for a simple way to acquire consent from patients for specific treatments.
How Does the Health Consent Form Template Work?
The Health Consent Form Template requires the WPForms Pro License and the Signature Addon to collect patient information and acquire their consent via a digital signature for any recommended treatments. Fields include:
- Patient Information:
- Full Name: Records the patient’s name for accurate identification
- Gender: Notes the patient’s gender, critical for personalizing care.
- Date of Birth: Essential for verifying the patient’s age for medical records
- Email Address: A means to communicate important information or updates.
- Phone Number: Direct contact information for any immediate communication.
- Emergency Contact:
- Full Name: Information of someone to contact in case of an emergency.
- Relationship to the Patient: Clarifies the emergency contact’s relationship.
- Email Address: For non-urgent communications or updates.
- Phone Number: A secondary means of urgent communication.
- Authorization:
- Treatment Information: Detailed description of the treatment.
- Consent: A series of statements the patient or guardian must agree to.
- Signature and Date: A field for the digital signature of the patient.
Sign up with WPForms today and access the Health Consent Form Template. It is ideal for medical clinics, hospitals, and healthcare practitioners requiring a solution to managing patient consent efficiently and securely.
