Genetic Testing Consent Form

Genetic Testing Consent Form — Form Fields

This healthcare template includes 9 fields. Obtain patient informed consent for genetic testing including purpose, risks, and privacy implications. Free to customize and use on ZenBuild.

• Patient Full Name (text, required)
• Date of Birth (text, required)
• Patient Email (email, required)
• Ordering Provider (text, required)
• Test Being Ordered (text, required)
• Purpose of Testing (dropdown selection, required) — options: Diagnostic, Carrier screening, Predictive/risk assessment, Pharmacogenomics, Prenatal, Research
• Patient Questions or Concerns (long text, optional)
• I Understand and Agree That (checkboxes, required) — options: Results may have implications for family members, Results may be inconclusive, Insurance may be impacted, I may withdraw consent at any time, Results will be shared with my care team
• Do You Wish to Receive Results Regardless of Outcome? (multiple choice, required) — options: Yes, No, Only positive results