Patient Agreement To Investigation Or Treatment
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7Consent form 1
Patient agreement to investigation
or treatment
Patient details (or pre-printed label)
Patient's surname/family name ………………………….
Patients first name………………………………………..
Date of birth………………………………………………..
NHS number (or other identifier) ………………………..
Male
Female
Special requirements…………………………………………
(eg other language/other communication method)
Responsible Health Professional ………………………..
Job Title ……………………………………………………
To be retained in patient's notes
Quality and Governance Service
Updated November 2013
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