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Library of Printable Patient Consent Form Examples

The Electronic Forms Library Project for Hospitals and Healthcare Systems

About the Electronic Forms Library Project

As the leading healthcare eConsent Solution, we have collected over 70,000 (YES SEVENTY-THOUSAND) healthcare forms in the last 20 years, including an array of department specific informed consent form samples, and we want to make these examples available to healthcare organizations of all types in an effort to serve. Below you will find the quick access table of contents where we have organized over 280 of the most common hospital forms and patient consent examples by department, including polst form samples, printable HIPAA consent forms, medical procedure patient consent forms, patient intake forms, and many other patient consent forms in Spanish and English.

We feel that it is our primary directive to serve those that serve others, so if you don't find what you're looking for, contact us and we'll be happy to help!
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20 Years of Closing "Paper-Gaps" in Hospitals

For 20 years Access eForms has helped over 1,000 hospitals convert paper forms to EHR integrated electronic form and patient eSignature solutions. Along the way we've amassed quite the library of form examples from a variety of departments along the way including Patient Intake and Registration, Anesthesiology, Radiology, Obstetrics and Gynecology, Orthopaedics, and more.

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Whenever you are ready to convert your paper forms to EHR integrated eForm solutions we've got you covered. Most commonly MEDITECH, Epic, and Cerner hospitals leverage our solutions towards patient electronic signature capture for consents.

 

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Electronic Forms Library

Table of Contents

Click to View Forms by Department

  General Forms  

back-office_eforms
Admission Orders IMG

Admission Orders

Admitting Medical Floor Treatment Orders IMG

Admitting Medical Floor Treatment Orders

AUTHORIZATION TO TRANSFER

AUTHORIZATION TO TRANSFER

Disclosure & Consent Medical & Surgical Procedures DISCLCONS IMG

Disclosure & Consent Medical & Surgical Procedure

DISCLOSURE AND CONSENT MEDICAL AND SURGICAL PROCEDURES DCMS002 IMG

DISCLOSURE AND CONSENT MEDICAL AND SURGICAL PROCEDURES

Fall Risk Form IMG

Fall Risk Form

FINANCIAL AGREEMENT FOR PATIENTS ENROLLED IN HEALTHCARE PLANS - svmh8530_6937 IMG

FINANCIAL AGREEMENT FOR PATIENTS ENROLLED IN HEALTHCARE PLANS

ICU Admission Orders IMG

ICU Admission Orders

VACCINE DOCUMENTATIONCONSENT FORM IMG

VACCINE DOCUMENTATION CONSENT FORM

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  Anesthesiology Form Examples  

Anesthesiology
ANESTHESIA CONSENT IMG

ANESTHESIA CONSENT

ANESTHESIOLOGY CHARGE VOUCHER - LCGH_8018 IMG

ANESTHESIOLOGY CHARGE VOUCHER

ANESTHESIOLOGY PRE OPERATIVE EVALUATION SP0010-502 IMG

ANESTHESIOLOGY PRE OPERATIVE EVALUATION

CONSENT FOR SURGERY, ANESTHESIA AND OTHER MEDICAL PROCEDURES - DA-018 IMG

CONSENT FOR SURGERY, ANESTHESIA AND OTHER MEDICAL PROCEDURES

GENERAL INFORMATION FOR ANESTHESIA IMG

GENERAL INFORMATION FOR ANESTHESIA

HIGH RISK ANESTHESIA ASSESSMENT INSTRUCTIONS DH-020 IMG

HIGH RISK ANESTHESIA ASSESSMENT INSTRUCTIONS

Physician Anesthesia Orders − Pre − & Post− Op anesthorders IMG

Physician Anesthesia Orders

PREOPERATIVE ANESTHESIA ASSESSMENT - Assmt_PreOp IMG

PREOPERATIVE ANESTHESIA ASSESSMENT

REQUEST FOR ANESTHESIA - 604_010_1 IMG

REQUEST FOR ANESTHESIA 

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  Bariatric Forms  

BARIATRIC_Surgery_Consent_Forms_1
CHECKLIST FOR EGDS AND COLONOSCOPIES  CHCKLSTFOREGDS_COLCOPIES IMG

CHECKLIST FOR EGDS AND COLONOSCOPIES

CONSENT FORM (FMT) DONOR GASTRO ZENDO_FMT_DONOR_CONSENT IMG

CONSENT FORM (FMT) DONOR GASTRO ZENDO

CONSENT FORM (FMT) RECIPIENT Gastro ZENDO_FMT_RECP_CONSENT IMG

CONSENT FORM (FMT) RECIPIENT Gastro ZENDO

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Gastric Bypass Post Op Order IMG

Gastric Bypass Post Op Order

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PHYSICIAN’S ORDERS AND TREATMENTS SAME DAY CARE CENTER LAPAROSCOPIC ADJUSTABLE GASTRIC IMG

PHYSICIAN’S ORDERS AND TREATMENTS LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING-POST-OP

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POST OPERATIVE ORDERS FOR LAPAROSCOPIC GASTRIC BANDING IMG

POST OPERATIVE ORDERS FOR LAPAROSCOPIC GASTRIC BANDING

POST OPERATIVE ORDERS FOR LAPAROSCOPIC SLEEVE GASTRECTOMY IMG

POST OPERATIVE ORDERS FOR LAPAROSCOPIC SLEEVE GASTRECTOMY

Post-Op Bariatric Orders IMG

Post-Op Bariatric Orders

  Cardiology Forms  

cardiology_Consent_form_samples
CARDIOLOGY PROGRESS NOTE IMG

CARDIOLOGY PROGRESS NOTE

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CARDIOLOGY STRESS TEST HISTORY FORM - DA-173 IMG

CARDIOLOGY STRESS TEST HISTORY 

CARDIOTHORACIC SURGERY CONSULTATION REPORT AND HISTORY & PHYSICAL EXAM IMG

CARDIOTHORACIC SURGERY CONSULTATION REPORT

Cardiovascular informed Consent - bhd_87 IMG

CARDIOVASCULAR INFORMED CONSENT

CARDIOVERSION DISCHARGE INSTRUCTIONS s02431 IMG

CARDIOVERSION DISCHARGE INSTRUCTIONS

CathEP Lab Procedural Checklist and Flowsheet - SP0020-516 IMG

CathEP Lab Procedural Checklist and Flowsheet

ED ADMIT − CARDIAC - ed_admit_cardiac IMG

ED ADMIT − CARDIAC

INFORMED CONSENT FOR CARDIAC CATHETERIZATION AND INTERVENTIONS - CONSENT44 IMG

INFORMED CONSENT FOR CARDIAC CATHETERIZATION AND INTERVENTIONS

INVASIVE CARDIOLOGY PREPROCEDURE GENERATOR CHANGE ORDERS  - s02352 IMG

INVASIVE CARDIOLOGY PREPROCEDURE GENERATOR CHANGE ORDERS

SPANISH INFORMED CONSENT FOR INTERVENTIONAL CARDIOLOGY - 50462HS IMG

SPANISH INFORMED CONSENT FOR INTERVENTIONAL CARDIOLOGY

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  Emergency Department Forms  

emergency_department_consent_forms_Examples
CONSENT FOR EMERGENCY TREATMENT sm02407_02423mrpg1 IMG

CONSENT FOR EMERGENCY TREATMENT

CONSENT FOR EXAMINATION AND TREATMENT ED PAC_MR110 IMG

CONSENT FOR EXAMINATION AND TREATMENT ED

ED COMPLIANCE DECLINATION SCREENING FORM - DECLTR IMG

ED COMPLIANCE DECLINATION SCREENING FORM

ED EMERGENCY DEPARTMENT DOCUMENT SCANNING CHECKLIST ED_SCANCHECK IMG

ED EMERGENCY DEPARTMENT DOCUMENT SCANNING CHECKLIST

ED QUAL CHART ED_SAFS IMG

ED QUAL CHART ED

ED TRANSFER AUTHORIZATION  REFUSAL FORM ED_TRANSREF IMG

ED TRANSFER AUTHORIZATION REFUSAL FORM

Emergency Department Assault IMG

Emergency Department Assault

Emergency Department Burn IMG

Emergency Department Burn

EMERGENCY ROOM SCREENING ASSESSMENT RECORD - ER_SCREENING IMG

EMERGENCY ROOM SCREENING ASSESSMENT RECORD 

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ER Charge Sheet IMG

ER Charge Sheet

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  Nephrology Forms  

nephrology_consent_forms_examples
CHP ULTRASOUND GUIDED RENAL BIOPSY (POST−BIOPSY) ORDERS - PO0010-1353 IMG

CHP ULTRASOUND GUIDED RENAL BIOPSY (POST−BIOPSY) ORDERS

HEART TRANSPLANT ACUTE REJECTION ADMISSION ORDERS FOR ADULTS - PO0010-1298 IMG

HEART TRANSPLANT ACUTE REJECTION ADMISSION ORDERS FOR ADULTS

HEMODIALYSIS PATIENT CARE ORDERS  - svmh7170_022000pg2 IMG

HEMODIALYSIS PATIENT CARE ORDERS

PRE PRINTED ORDER HEPATITIS B IMMUNIZATION USING ENGERIX IMG

PRE PRINTED ORDER HEPATITIS B IMMUNIZATION FOR NEPHROLOGY PATIENTS USING ENGERIX

PRE PRINTED ORDER OUT−PATIENT CHRONIC HEMODIALYSIS- CRO6039 IMG

PRE PRINTED ORDER OUT−PATIENT CHRONIC HEMODIALYSIS

RENAL TRANSPLANT OUTPATIENT LIVE DONOR RECIPIENT IMG

RENAL TRANSPLANT OUTPATIENT LIVE DONOR RECIPIENT

ROUTINE NEPHROLOGY ASSOCIATES ORDERS - phy00101 IMG

ROUTINE NEPHROLOGY ASSOCIATES ORDERS

SAMSCA DOSING PROTOCOL NEPHROLOGY DA-217 IMG

SAMSCA DOSING PROTOCOL NEPHROLOGY

XIGRIS (DROTRECOGIN ALFA) ORDER SET - PO058 IMG

XIGRIS (DROTRECOGIN ALFA) ORDER SET

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  Obstetrics & Gynecology Forms  

obstetrics_consent_forms_examples
CONSENT CIRCUMCISION

CONSENT CIRCUMCISION

DEPARTMENT OB−GYN REFUSAL OF TREATMENT SPANISH - 50458P IMG

DEPARTMENT OB−GYN REFUSAL OF TREATMENT SPANISH

DRUG TESTING CONSENT FORM - 43780HS IMG

DRUG TESTING CONSENT FORM OB - GYN

GRAPHIC CHART OBSTETRICS - 702_006_2 IMG

GRAPHIC CHART OBSTETRICS

GYNECOLOGICAL HISTORY - GYNCOLOGCLHX IMG

GYNECOLOGICAL HISTORY

Gynecology History OBGYNHX IMG

Gynecology History OBGYNHX

NURSING ADMISSION RECORD OBSTETRICS - NURSING034 IMG

NURSING ADMISSION RECORD OBSTETRICS

NURSING ASSESSMENT SHORT STAY FORMENDOSCOPY - Endo_NsgAssmt_SS_Form IMG

NURSING ASSESSMENT SHORT STAY FORM

OBGYN PRACTICE GYNECOLOGICAL RECORD IMG

OBGYN PRACTICE GYNECOLOGICAL RECORD

RADIATION ONCOLOGY HIGH DOSE RATE BRACHYTHERAPY GYNECOLOGICAL ADMISSION ORDERS IMG

RADIATION ONCOLOGY HIGH DOSE RATE BRACHYTHERAPY GYNECOLOGICAL ADMISSION ORDERS

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  Oncology Forms  

oncology_consent_forms_examples 2
COUMADIN FLOW-SHEET - ul793132 IMG

COUMADIN FLOW-SHEET

MEDICAL ONCOLOGYHEMATOLOGY OUTPATIENT ORDER - ul793206 IMG

MEDICAL ONCOLOGYHEMATOLOGY OUTPATIENT ORDER 

Oncology Admission Note PHY_ONCADMNT IMG

Oncology Admission Note

Oncology Clinic Charges - ONC_CHARGES IMG

Oncology Clinic Charges

ONCOLOGY OUTPATIENT CENTER MEDICATION ADMINISTRATION RECORD - ONC_OUTPTCT IMG

ONCOLOGY OUTPATIENT CENTER MEDICATION ADMINISTRATION RECORD

ONCOLOGY PHYSICIAN’S CONSULTATION REPORT PHY_ONCCONSU IMG

ONCOLOGY PHYSICIAN’S CONSULTATION REPORT

Oncology Physician’s Progress Note - PHY_ONCPHYPN IMG

Oncology Physician’s Progress Note 

ONCOLOGY PROGRESS NOTE − INFUSION THERAPY - PHY_ONCPN IMG

ONCOLOGY PROGRESS NOTE − INFUSION THERAPY

OUTPATIENT ONCOLOGY INITIAL REFERRAL - ul793136 IMG

OUTPATIENT ONCOLOGY INITIAL REFERRAL

RADIATION ONCOLOGY CONSULTATION FORM - RAD_PTHISPHY IMG

RADIATION ONCOLOGY CONSULTATION FORM

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  Ophthalmology Forms  

Ophthalmology _consent_forms_examples 2
AMBULATORY CARE PROCEDURE RECORD - W-OPD-3 IMG

AMBULATORY CARE PROCEDURE RECORD

OPHTHALMOLOGY RECORD RETINOFPRMATUR IMG

OPHTHALMOLOGY RECORD RETINO

Physician’s Orders Pre and post−operative orders for Eye Surgery (Adult) - 841754 IMG

Physician’s Orders Pre and post−operative orders for Eye Surgery

SPECIAL OPHTHALMOLOGY PREMATURETINOP IMG

SPECIAL OPHTHALMOLOGY PREMATURE

STANDING ORDERS RETINAL SURGERY, PRE−OP - ORD_409_40212 IMG

STANDING ORDERS RETINAL SURGERY, PRE−OP

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  Orthopedic Forms  

Orthopedic_consent_forms_examples-1
DISCHARGE INSTRUCTIONS − PHYSICAL THERAPY, ORTHOPAEDIC - 640_50059 IMG

DISCHARGE INSTRUCTIONS − PHYSICAL THERAPY, ORTHOPAEDIC

DISCHARGE INSTRUCTIONS FOLLOWING FOOT AND ANKLE SURGERYDIN032 IMG

DISCHARGE INSTRUCTIONS FOOT AND ANKLE SURGERY

FOR USE WITH ORTHOPEDIC ORDER SET ONLY MEDICATION ADMINISTRATION RECORD  s02414_pg1 IMG

FOR USE WITH ORTHOPEDIC ORDER SET ONLY MEDICATION ADMINISTRATION RECORD

ORTHO TRAUMA ADMIT ORDERS shm0081 IMG

ORTHO TRAUMA ADMIT ORDERS

ORTHOPAEDICS OUTPATIENT DISCHARGE INSTRUCTIONS - DISCHARGE004 IMG

ORTHOPAEDICS OUTPATIENT DISCHARGE INSTRUCTIONS

ORTHOPEDIC POST−OPERATIVE OUTPATIENT ORDERS shm0082 IMG

ORTHOPEDIC POST−OPERATIVE OUTPATIENT ORDERS

PHYSICAL THERAPY CHARGE SLIP - 1110504 IMG

PHYSICAL THERAPY CHARGE SLIP

PRE PRINTED ORDER POST OPERATIVE ORTHOPAEDIC ORO6117 IMG

PRE PRINTED ORDER POST OPERATIVE ORTHOPAEDIC

PRE−OPERATIVE ORDERS − INPATIENT ORTHO shm0109 IMG

PRE−OPERATIVE ORDERS − INPATIENT ORTHO 

TRANSFER ORDERS FOR ORTHOPEDIC PATIENTS  shm0059 IMG

TRANSFER ORDERS FOR ORTHOPEDIC PATIENTS

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  Physiotherapy Forms  

psysiotherapy_consent_forms_examples
CONSENT TO RECEIVE ANTIDEPRESSANTS FRM_132 IMG

CONSENT TO RECEIVE ANTIDEPRESSANTS

MENTAL HEALTH SERVICES THERAPY ASSESSMENT (SENIOR LIFESTYLES) - THERAPY006 IMG

MENTAL HEALTH SERVICES THERAPY ASSESSMENT (SENIOR LIFESTYLES)

PATIENT SATISFACTION QUESTIONNAIRE - THERAPY012 IMG

PATIENT SATISFACTION QUESTIONNAIRE - THERAPY

PRE−ADMISSION SCREEN − MENTAL ILLNESSRETARDATION - PREADMSCRNNRSFC IMG

PRE−ADMISSION SCREEN − MENTAL ILLNESS RETARDATION

RESTRAININITIAL IMG

RESTRAIN INITIAL

RESTRAINRENEWAL IMG

RESTRAIN RENEWAL

RIGHTS OF INDIVIDUALS RECEIVING MENTAL HEALTH AND DEVELOPMENTAL DISABILITY IMG

RIGHTS OF INDIVIDUALS RECEIVING MENTAL HEALTH AND DEVELOPMENTAL DISABILITY SERVICES

SEDATION_RECORD IMG

SEDATION RECORD

SF−36V2 HEALTH SURVEY - THERAPY001 IMG

HEALTH SURVEY - THERAPY

THERAPY PROGRESS NOTE AND TREATMENT LOG - THERAPY003 IMG

THERAPY PROGRESS NOTE AND TREATMENT LOG

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  Radiology Forms  

radiology_consent_forms_examples
ENG SPAN AUTHORIZATION AND CONSENT TO SURGERY OR SPECIAL THERAPEUTIC PROCEDURES IMG

ENG/SPAN AUTHORIZATION AND CONSENT TO SURGERY OR SPECIAL DIAGNOSTIC OR THERAPEUTIC PROCEDURES

INFORMED CONSENT DIAGNOSTIC PROCEDURES RADIOLOGY - CONSENT17 IMG

INFORMED CONSENT DIAGNOSTIC PROCEDURES RADIOLOGY

INFORMED CONSENT TREATMENT OF HYPERTHYROIDISM WITH RADIOACTIVE IODINE CONSENT38 IMG

INFORMED CONSENT TREATMENT OF HYPERTHYROIDISM WITH RADIOACTIVE IODINE

Interventional Radiology Nursing Flowsheet IMG

Interventional Radiology Nursing Flowsheet

Off-Site Physician Radiology Request IMG

Off-Site Physician Radiology Request

Radiology Discharge Instructions IMG

Radiology Discharge Instructions

Radiology Downtime Request IMG

Radiology Downtime Request

Radiology Imaging Questionnaire IMG

Radiology Imaging Questionnaire

Radiology MRI Safety Screen and Patient History IMG

Radiology MRI Safety Screen and Patient History

RADIOLOGY SPECIAL PROCEDURES NOTES - RA0010 IMG

RADIOLOGY SPECIAL PROCEDURES NOTES

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  Registration & Patient Intake Forms  

patient_intake_registration_forms_examples 2
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION IMG

AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION

AUTHORIZATION TO TRANSFER IMG

AUTHORIZATION TO TRANSFER

Behavioral Health General Consent - English

Behavioral Health General Consent - English

Behavioral Health General Consent - Spanish IMG

Behavioral Health General Consent - Spanish

CONDITIONS OF SERVICES - English IMG

CONDITIONS OF SERVICES - English

CONDITIONS OF SERVICES - Spanish IMG

CONDITIONS OF SERVICES - Spanish

General Consent 1 IMG

General Consent 1

General Consent 2 IMG

General Consent 2

GENERAL CONSENT FOR ADMISSION IMG

GENERAL CONSENT FOR ADMISSION

GENERAL CONSENT FOR TREATMENT AND PATIENT AUTHORIZATION RECORD IMG

GENERAL CONSENT FOR TREATMENT AND PATIENT AUTHORIZATION RECORD

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  Screening Forms  

medical_screening_forms_examples
HISTORY AND PHYSICAL - sm02_368pg3 IMG

HISTORY AND PHYSICAL

Imaging Department MRI Screening Form  - sv43 IMG

Imaging Department MRI Screening Form

INFANT SCREENING RESULTS s02179 IMG

INFANT SCREENING RESULTS

Patient Eligibility Screening Record Vaccines for Children Program IMG

Patient Eligibility Screening Record Vaccines for Children Program

PEDIATRIC NUTRITIONAL SCREENING - pnaa_3 IMG

PEDIATRIC NUTRITIONAL SCREENING

SIBLING SCREENING QUESTIONNAIRE  - s02440 IMG

SIBLING SCREENING QUESTIONNAIRE

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  Urology Forms  

urology_consent_forms_examples 2
ORDER SET UROLOGY ADMISSION OR POST−OP - ORD_409_40116 IMG

ORDER SET UROLOGY ADMISSION OR POST−OP

PRE PRINTED ORDER RADICAL PROSTATECTOMY POST−OP ORDERS FOR UROLOGY ORO6047 IMG

PRE PRINTED ORDER RADICAL PROSTATECTOMY POST−OP ORDERS FOR UROLOGY

PRE−OP UROLOGY ORDERS - fp1111-2078 IMG

PRE−OP UROLOGY ORDERS

SURGICAL COUNT UROLOGY SP0150-98 IMG

SURGICAL COUNT UROLOGY 

Urology Clinic Nursing Assessment - med216 IMG

Urology Clinic Nursing Assessment

Urology HISTORY PHYSICAL CONSULT IMG

HISTORY PHYSICAL CONSULT

UROLOGY POST OPERATIVE ORDERS s02401 IMG

UROLOGY POST OPERATIVE ORDERS

Urology Urology HISTORY PHYSICAL CONSULT IMG

Urology HISTORY PHYSICAL CONSULT

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