Treatment Consent & Information Record
Informed consent conversations happen quickly, often right before a procedure, and rarely get written down from your side. Keep your own record of exactly what you were told — in your own words, at the time it happened.
If a complication or dispute arises later, there's usually no record from your side
Consent forms typically capture that a conversation happened, not what was actually said — the specific risks mentioned, the alternatives discussed, or the questions you asked and how they were answered. If a complication or a dispute comes up later, the provider's paperwork is often the only account on record, and it wasn't written from your perspective.
This record gives you a place to write down what was actually explained, as soon as possible after the conversation, while it's still fresh.
- Pre-Treatment Information Log — what was explained about the treatment itself
- Risks & Alternatives Discussed — captured in your own words
- Questions Asked & Answers Given — your own record of the exchange
- Consent Date & Signature Note — when the conversation happened
Step by step
- Download the record (PDF version).
- Fill it out as soon as possible after — or during — the consent conversation.
- Note what was explained about the treatment, its risks, and any alternatives offered.
- Record any questions you asked and the answers you were given.
- Date it and keep it with your own records, separate from the provider's paperwork.
Anyone about to undergo a treatment or procedure
A contemporaneous record of the consent conversation, written from your own perspective and independent of the provider's own documentation.
- Print-ready PDF version
- Pre-Treatment Information Log
- Risks & Alternatives Discussed section
- Questions Asked & Answers Given section
- Works on any device
Write down what was actually said, while it's still fresh.
Your own record of the consent conversation — before you need it, not after.
Get it — $5.90 →One-time $5.90 · PDF · Works on any device