Consent Forms

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Contents

Gynaecology

Document Date Source
Patient agreement to investigation or treatment for Hysteroscopy 2007 Salisbury NHS Foundation Trust

Abortion

Document Date Source
Patient agreement to investigation or treatment for Early Medical Abortion 2010 Salisbury NHS Foundation Trust
Patient agreement to investigation or treatment for Vacuum Termination of Pregnancy 2010 Salisbury NHS Foundation Trust

Investigations

Document Date Source
Patient agreement to investigation or treatment for Amniocentesis 2007 Salisbury NHS Foundation Trust
Patient agreement to investigation or treatment for Chorionic Villus Sample 2007 Salisbury NHS Foundation Trust


Labour

Document Date Source
Consent to Photograph and/or Videotape in Labor and Delivery (RAVEN Program) 2010 USA: University of Virginia Health System


Caesarean Section

Document Date Source
Care Bundle for women with previous Caesarean Section at risk of a morbidly adherent placenta see p.20-23 Consent form 1. Patient agreement to investigation or treatment. Elective Caesarean Section for placenta praevia in the presence of a previous Caesarean Section Perinatal Institute
RCOG Consent Advice 12: Caesarean Section for Placenta Praevia 2010 Royal College of Obstetricians & Gynaecologists
RCOG Consent Advice 7: Caesarean Section 2009 Royal College of Obstetricians & Gynaecologists
Caesarean Section Consent Form 2004? AUSTRALIA: Queensland Government
Consent Form for Lower Segment Caesarean Section AUSTRALIA: Government of Western Australia Department of Health
Consent form for Birth after Cesarean (Caesarean or VBAC) 2011 CANADA: BC Women's Hospital & Health centre
Consent for Cesarean Delivery and Administration of Anesthesia or Sedation 2012 USA: University of Virginia Health System
Consent for Cesarean Delivery and Therapeutic Sterilization and Administration of Anesthesia or Sedation 2012 USA: University of Virginia Health System
Cesarean Section Delivery Consent undated USA: Temple Health, Philadelphia
Elective Primary Cesarean Section consent form 2010 USA: CRICO (Harvard)
example of consent form and blog article 2009 USA: Doula Momma blog
example of consent form and blog article undated USA: VBACfacts blog



Vaginal Birth After Caesarean (VBAC)

Document Date Source
Consent form for Birth after Cesarean (Caesarean or VBAC) 2011 CANADA: BC Women's Hospital & Health centre
Consent for Vaginal Birth after Cesarean (VBAC) Delivery and Administration of Anesthesia or Sedation 2010 USA: University of Virginia Health System
Vaginal Birth after Cesarean Section Patient Consent Form USA: Genesis Ob/Gyn, Bridgeton, MO
Vaginal Birth after Cesarean Consent Form (VBAC consent) USA: Midwifery Services, Hampstead, NC
Consent For Vaginal Birth After Cesarean Section (VBAC) USA: Bellingham Ob Gyn Associates
Trial of Labor/Vaginal Birth after Cesarean Delivery Consent Form USA: Medical Mutual Insurance Company of Maine
Trial of Labor after Cesarean Section (TOLAC) Patient Consent Form USA: Advanced Ob-Gyn, Grand Rapids, Michigan
Consent for Birth After Cesarean Section 2002 USA: Dartmouth-Hitchcock, Vermont

Cord Clamping

Document Date Source
Informed Consent for Clamping the Umbilical Cord - meaning in this case delayed clamping. USA: Autism End It Now campaign group



Perinatal Death

Document Date Source
Paediatric Post Mortem Consent Form and information leaflet 2010 Southampton University Hospital NHS Trust (also used at Salisbury NHS Foundation Trust)






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