Consent

Genetic Testing Consent Form

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Genetic Testing Consent Form

Page 1 of 2

Patient Name
Jane Martinez
Date of Birth
03/15/1985
Test Type & Indication
Select an option...
Scope of Testing Explained
Potential Results & Limitations
Secondary Findings Preference
Option A
Option B
Option C
Family Implications Acknowledged
Genetic Privacy & GINA Rights
Specimen Storage & Biobanking Consent
Strongly agree
Agree
Neutral
Disagree
Research Data Sharing Consent
Strongly agree
Agree
Neutral
Disagree
Genetic Counseling Acknowledgment
Right to Withdraw Consent
I agree to the terms above
Sign here
Patient Signature
Sign here
Ordering Provider Signature
Sign here
Submit
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The Genetic Testing Consent Form provides comprehensive informed consent documentation for patients undergoing clinical genetic or genomic testing. This template addresses the unique ethical and legal considerations inherent in genetic testing, including the scope of testing (single-gene, multi-gene panel, whole-exome, or whole-genome sequencing), the types of results that may be returned (positive, negative, variant of uncertain significance), and the possibility of incidental or secondary findings unrelated to the primary indication. The form explains concepts such as analytical validity, clinical validity, and clinical utility in patient-accessible language.

The consent covers critical aspects specific to genetic medicine including the implications of test results for biological relatives, the potential for genetic discrimination (with reference to GINA protections and state-specific genetic privacy laws), the limitations of negative results in the context of residual risk, and the distinction between diagnostic and predictive testing. Patients are given the option to elect or decline categories of secondary findings consistent with ACMG recommendations for reporting of secondary findings in clinical exome and genome sequencing.

Data privacy sections detail how genetic specimens and sequence data will be stored, whether de-identified data may be contributed to research databases or variant repositories (e.g., ClinVar, gnomAD), and the patient's rights regarding biobanking and future reanalysis. Pre-test and post-test genetic counseling acknowledgments are captured, along with dual signatures from the patient and ordering provider, creating a complete audit trail that satisfies CAP/CLIA laboratory requirements and institutional policies for genomic medicine.

What's included

  • Test scope and indication documentation
  • Secondary findings election or declination
  • Genetic privacy and anti-discrimination rights
  • Specimen storage and biobanking preferences
  • Pre-test and post-test counseling acknowledgment
  • Dual signatures with ordering provider attestation
  • Consent agreement with e-signature

Who uses this template

  • Clinical genetics and genomic medicine programs
  • Hereditary cancer risk assessment clinics
  • Prenatal and reproductive genetics screening
  • Pharmacogenomic testing before medication therapy

All form fields

14 fields across 2 pages. Customize any field after signing up.

Patient NameText
Date of BirthDate
Test Type & IndicationDropdown
Scope of Testing ExplainedCheckbox
Potential Results & LimitationsCheckbox
Secondary Findings PreferenceMultiple Choice
Family Implications AcknowledgedCheckbox
Genetic Privacy & GINA RightsCheckbox
Specimen Storage & Biobanking ConsentMultiple Choice
Research Data Sharing ConsentMultiple Choice
Genetic Counseling AcknowledgmentCheckbox
Right to Withdraw ConsentConsent Agreement
Patient SignatureE-Signature
Ordering Provider SignatureE-Signature

How to use the Genetic Testing Consent Form

Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Genetic Testing Consent Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.

Setup steps

  1. 1Choose the template. Find the Genetic Testing Consent Form in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 14 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

Is the Genetic Testing Consent Form HIPAA compliant?

Yes. All Formisoft templates, including the Genetic Testing Consent Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.

Does this template work on mobile devices?

Yes. The Genetic Testing Consent Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

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