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Simple Informed Consent Form Template

Easily Manage Patient Consent with This User-Friendly Template

Navigating the complexities of informed consent can be overwhelming, but you don't have to do it alone. This simple informed consent form template is designed for healthcare providers and researchers who want to ensure clear communication and compliance with regulatory standards. You can enhance transparency, protect patient rights, and streamline your documentation process, all while staying organized and compliant. Perfect for clinical trials and patient agreements, this template guides you through necessary disclosures with ease. Try using the live template to simplify your workflow.

Study or procedure title
Organization or researcher name
Contact email for questions
Your full name
Your email (to receive a copy of this consent)
Participant name if signing on behalf of a minor or another person (optional)
I am 18 years of age or older
Yes
No
I have read and understood the information provided about this study/procedure.
Yes
No
I had the opportunity to ask questions and received answers that satisfied me.
Yes
No
I understand that my participation is voluntary and I can withdraw at any time without penalty.
Yes
No
I understand the information about potential risks and discomforts.
Yes
No
Not applicable
I understand the information about potential benefits.
Yes
No
Not applicable
I consent to the collection and processing of my personal data as described.
Yes
No
I consent to audio, photo, or video recording, if applicable.
Yes
No
Not applicable
I permit the use of my de-identified data for research, publication, or quality improvement.
Yes
No
I agree to be contacted about future related studies.
Yes
No
I freely give my informed consent to participate in this study/procedure.
Yes
No
Typed full name as signature
Date of signature
{"name":"Study or procedure title", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Study or procedure title, Organization or researcher name, Contact email for questions","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration showcasing a simple informed consent form template for FormCreatorAI article

When to use this form

Use this template when you need clear, quick permission before a service, study, or program. It fits clinics, therapists, coaches, schools, and small businesses that need a simple record of agreement. For research, send it before surveys, interviews, or pilot tests; if your study is detailed, use the Research consent form. In private practice, share it prior to the first session to set expectations on scope and boundaries; for counseling-specific needs, see the Professional counselling informed consent form. If you work online or by telehealth, collect signatures remotely with the Electronic informed consent form. The result: people understand what will happen, their rights, and how you use their data, and you have defensible proof of consent.

Must Ask Simple Informed Consent Questions

  1. Do you understand the purpose, what will happen, and how long it will take?

    This confirms comprehension before you ask for consent. It reduces confusion and helps you tailor any follow-up explanations.

  2. Do you understand the possible risks, discomforts, and benefits?

    Stating risks and benefits up front leads to informed choices. It also documents that you discussed potential downsides and expected value.

  3. Is your participation voluntary, and can you withdraw at any time without penalty?

    Reminding people they can stop at any time prevents pressure and builds trust. It improves participation because people feel in control.

  4. Do you agree to how your information will be collected, stored, shared, and kept confidential?

    This guards privacy and clarifies limits on use, storage, and sharing. If you need a dedicated policy, pair your form with the Counseling confidentiality form.

  5. Do you consent to take part and confirm with your signature and date?

    A clear yes plus a signature creates a valid record. It protects both parties and speeds audits or dispute resolution.

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