Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
HIV Testing Consent Form
Your information
Patient Full Name *
Date of Birth
____ / ____ / ________
Test Type
Pre-Test Information Reviewed
Confidentiality Protections Acknowledged
Counseling Services Offered
Additional details
Preferred Results Notification Method
Right to Decline Testing Acknowledged
Consent to HIV Testing
Your practice's consent wording goes here.
Signature
Date
Patient Signature
Date
Date of Consent
____ / ____ / ________
HIV Testing Consent Form template from formisoft.com. formisoft.com/intake-templates/hiv-testing-consent