Consent form templates for clinics
Eight consent forms that share one layout: what the procedure involves in plain words, the risks your doctor writes in, separate photo consent, and signatures for the patient, guardian, witness, doctor and interpreter.
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- Word · English.docx · 43 KB
- PDF · English.pdf · 548 KB
- Word · Arabic.docx · 44 KB
- PDF · Arabic.pdf · 443 KB
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What is in the pack
| The eight forms | Laser hair removal; injectables (filler and botulinum toxin); chemical peel and skin treatments; minor surgical procedure; plastic surgery; physiotherapy treatment; telehealth consultation; general consent to treatment and data processing. |
|---|---|
| Page one: the procedure | Patient details and the procedure fields, what it involves, expected benefits, common and rare risks under headings for the doctor to complete, alternatives, what happens if nothing is done, and what the patient commits to afterwards. |
| Page two: agreement | Three separate photo choices (file, teaching, marketing), a tick that questions were answered, the patient’s statement and signature, a guardian section for minors, a witness, the doctor’s declaration and an interpreter line. |
| Form-specific parts | Plastic surgery adds a time-to-reflect section and a revision policy line. Telehealth covers recording and dropped calls. General consent lists data choices one by one. |
| Footer | Every page carries a line asking you to review the form with your legal adviser before use. |
How to use it
Review it with your adviser
Have your legal adviser check the wording against the rules where you work before the first patient signs.
Fill in the risks
Open the Word file and write the common and rare risks for each procedure as your doctors explain them.
Print only what you need
Each form is two pages and starts on its own page, so you can print one form without the others.
Sign before the procedure
Go through page one with the patient, then sign page two together and keep it in their file.
Who it is for
Dermatology and aesthetic clinics, day-surgery and plastic surgery clinics, physiotherapy centres and any clinic offering video or phone consultations. The Arabic file runs right to left; the English file is the same pack in English.
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Questions
Why are the risks left blank?
Risks depend on the procedure, the product and the patient. Your doctor writes the ones that apply and explains them, which is the point of consent.
Are these forms legally valid as they are?
They are a starting layout, not legal advice. Requirements differ by country and specialty, so review them with your legal adviser before use.
Why is photo consent split into three ticks?
Agreeing to a photo for the medical file is not the same as agreeing to its use in teaching or marketing, so each is a separate choice.
Can I add my own procedure?
Yes. Copy any form in the Word file and rewrite the procedure page; the signature page stays the same.
Consent signed on the patient file
In Medicolize the form goes to the patient’s phone with the appointment confirmation, is signed there, and is stored against the visit with the version of the wording they saw. Thirty minutes on your own clinic.