Medical Consent Form
Collect patient consent for a medical intervention with a free online form template. The medical permission form includes the patient’s details, contact information, and insurance information. You can customize the acknowledgment and consent section to meet your healthcare practice requirements. Let patients complete the consent to treatment form before the appointment, then attach it to medical record, save it as a PDF, or print it.
Structure and logic of the form
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The calendar start view is set up to show the years of the decade. Thus, patients can quickly find the required date by year, then select the month and date without endless scrolling through the calendar.
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To make sure patients are over 18 years old, the dates within the last 18 years are disabled. Specify the available date range in the calendar to efficiently schedule appointments, follow-up consultations, or treatment plans, track vaccination expiry dates, and more.
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The Phone and Insurance Number fields accept only digits to prevent input errors. It's done with Masked Text field type. Use it to specify a particular format and ensure accurate data collection for patient details, including social security numbers, health insurance policy numbers, and medical IDs.
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The email fields only accept data that matches the specified pattern to ensure users enter valid emails. Patterns are an alternative to the Masked Text field to restrict user input. Choose from predefined patterns or create your own to verify patient information.
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Patients must agree to all the listed points in order to submit consent for medical intervention; otherwise, they will encounter an error. It is done by adding custom validation to the field. Add custom validation to a field or the entire form to confirm the vaccination period, require medical files to be uploaded, or verify data accuracy.
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Patients confirm the accuracy of the data they have provided with a signature.