Progestin Implant Consent Form

Resource Properties

Abstract:

This one-page document is a consent form for providers to use with patients who are having a subdermal contraceptive implant (progestin implant, Nexplanon) inserted. The consent form provides a checklist of important information for patients to read and check off to indicate their understanding before insertion of the implant. 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
Medical Review:
Yes
The English language resource was created or reviewed by a medical professional for quality and accuracy.
Development Method:
Resource developed in English and translated into other languages
Translation Review:
Community review
This translation was evaluated by a representative or group from the community for accuracy and cultural relevance.
Country:
N/A
Population:
N/A
Copyright:
Licensed by Creative Commons
Last Reviewed by Author(s):
12/5/2016
Record Last Updated:
4/24/2017

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