Use This Template

Adult Medical Consent Form

Use our free Adult Medical Consent Form to collect a patient’s consent and approval and provide medical authorities with the ability to perform medical treatments when needed. This template includes details about the form’s purpose as well as policies regarding consent, withdrawal, and financial information. If the patient is able to provide their own consent, they can sign the form and acknowledge the policies. If the patient is unable to provide their own consent, a surrogate can sign on their behalf. This version of our medical consent form is intended for adult patients. We have a template for the child version of a medical consent form available as well.

We also included an internal section for staff members to add notes and indicate once they’ve added this consent form to their medical file. Using workflow statuses and the Entries page, staff members can easily monitor each entry’s progress and status.

All data collected can be made HIPAA compliant with our Enterprise plan after signing our Business Associates Agreement (BAA). Additionally, our data encryption capabilities can help ensure your data is secure both at rest and in transit.

Customize and adjust this template by adding, removing, and editing fields as you see fit. You can keep your branding consistent among all your forms and create a style using our Organization Theme feature. You can directly embed this form onto your practice’s website as an option as well.

Adult Medical Consent Form

Use our adult medical consent form template to collect a patient's consent and approval prior to treatment.



  • Patient
  • Internal Staff


  • Incomplete
  • Submitted
  • Processed