Treatment Consent Form
Step 1 of 4
1

Treatment Details

Patient info + treatment plan

?
Set up your profile
Saved once — never re-enter
Curative
Best possible chance of cure
Disease control / Palliative
Control or shrink; improve quality of life
Adjuvant
After surgery / radiotherapy
Neo-adjuvant
Before surgery / radiotherapy
Tap a regimen — relevant side effects auto-select on the next step. Only adjust the few that don't apply.
Breast — CDK4/6 Inhibitors
Breast — HER2 & Chemo
Haematology / Immunotherapy / Supportive
GI & Other
IV
SC
Oral
Other
2

Side Effects

Auto-selected based on regimen — adjust as needed

Select a regimen on the previous step to auto-populate.
3

Your Declaration & Signature

Confirm + choose how patient signs

I have discussed the intended benefits and risks of the recommended treatment, including all available alternatives.
I have discussed potential side effects, including those that may occur in future, and that unlisted rare effects may exist.
I have explained what treatment involves and the patient's right to withdraw consent at any time.
I confirm the patient has capacity to give consent and I have explained the course of treatment and its intended benefit.
Sign here
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📧
Send to patient
Email link — they sign remotely
📱
Sign here now
Hand device to patient
4

Patient Consent

Please read carefully and sign below

Your Treatment Summary

Please read this form carefully. You have the right to change your mind at any time, including after signing. If you have questions please ask your care team before signing.

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Consent Complete