Informed Consent for Services template

1. Purpose and Nature of Service

• I have been informed of the purpose, nature, and expected process of the service to be provided, including what will be involved and roughly how long it is expected to take.

2. Risks, Benefits, and Alternatives

• I have been informed of the reasonably foreseeable risks and benefits of this service, and of any reasonable alternatives, including the alternative of receiving no service at all.

3. Capacity to Consent

• I confirm I have the capacity to understand this information and to make my own decision, and that I am giving my consent voluntarily and without pressure.

4. Confidentiality and Data Protection

• My personal information will be kept confidential and processed in accordance with the UK GDPR and Data Protection Act 2018, and shared only with my consent or as required by law.

5. Right to Withdraw

• I understand I may withdraw my consent at any time, without needing to give a reason, and without this affecting my right to future services.

Client Information

• Full NameText
• Date of BirthDate
• AddressText
• Phone / EmailText

Provider Information

• Provider NameText
• Role / Licence No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Provider SignatureSignature
• Date signed (provider)Date

• By signing below, I confirm I have read, understood, and voluntarily agree to the terms of this informed consent.