COVID-19 Consent Form

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Patient Information

Patient Name*

COVID-19 Consent Form

Notice to the Practice or Provider using the below form for Informed Consent -COVID- 19 Pandemic. This document is for reference purposes only It is intended to provide general guidance, is not legal advice and is not a statement regarding any standard of care. The language can be incorporated into an existing patient informed consent or provided as a separate form. If used as a separate form, It must be used in conjunction with other required federal and state patient documentation. This document does not take into account every law or requirement of federal, state. or local authorities which may be applicable to you or your practice site/s.
Consent*
Consent*
Consent*

Name
Signature Date*
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