Consent to Participate Form-Example


An example consent-to-participate form that was used in a technology-enhanced Care Transitions Intervention® pilot program. The example explains to patients what to expect and what is required if they participate in the program and asks for a signature if they wish to participate.


Program planners and managers, and professionals involved in care transitions programs and informed consent. Consumers/patients are the ultimate audience for the form.

Helpful Tips

For other examples of patient consent forms, visit other sections of the ADOPT Toolkit.

Welcome, visitor!

Please login to access the tool link.

Leave a Reply