IUD Consent Form

Resource Properties

Abstract:

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.

Author(s):
Reproductive Health Access Project
Country of Origin:
United States
Medical Reviewer:
Coming soon
Other Reviewer:
Coming soon
Development Method:
Resource developed in English and translated into other languages
Translation Method:
Community review
This translation was evaluated by a representative or group from the community for accuracy and cultural relevance.
Community Participation:
coming soon
Country:
N/A
Population:
N/A
Resource Creation Date:
Coming soon
Copyright:
Licensed by Creative Commons
Last Reviewed by Author(s):
8/26/2015
Record Last Updated:
4/24/2017

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English
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Chinese, Simplified
Document: Open (PDF, 85.20 KB)
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Chinese, Traditional
Document: Open (PDF, 113.11 KB)
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Spanish
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