IUD Consent Form
This one-page document is a consent form for providers to use with patients who are having an IUD inserted. The consent form provides a checklist of important information about Mirena, Skyla, Liletta, and Paragard IUD for patients to read and check off to indicate their understanding before insertion of IUD. It contains information about possible risks, side effects, and what the IUD does and does not protect the user against. It includes a place for the patient, provider, and a witness to sign and date. Providers can customize this consent form with their clinic’s information.
The English language resource was created or reviewed by a medical professional for quality and accuracy.
This translation was evaluated by a representative or group from the community for accuracy and cultural relevance.