Free template
Surgical consent form template
A consent form that records the conversation, not just the signature: benefits, alternatives, risks and anaesthesia, in writing.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe patient completes
- Practice details, reference and date
- Patient: name, date of birth and MRN
- Procedure or treatment, and anaesthesia
- What was explained: intended benefits, alternatives including no treatment, what the procedure involves, anaesthesia and its risks
- Material, serious or frequently occurring risks
- Clinician's signature, printed name and Irish Medical Council number
- Optional consents: photography for the medical record, blood transfusion if clinically required
- Patient's signature and date
- Notes on capacity, decision support, interpreter or advocate, and confirmation on the day
Using it well
- Your hospital's consent policy and your indemnifier's guidance govern the process; this form is a starting point, not a substitute for either.
- Consent is the discussion; record the risks you actually discussed with this patient.
- Confirm consent again on the day of the procedure, and note it.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Digital consent and procedures for private urologists.