Consent for injections in office 2026

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Depo-Provera is a hormonal birth control injection containing depo-medroxyprogesterone acetate (DMPA), effective for preventing pregnancy with 97-99% reliability. Administered every 13 weeks, it causes a resting state in the ovaries, preventing egg release. While it offers advantages like no daily medication and reduced risk of uterine cancer, it may cause side effects such as irregular bleeding and weight gain. It does not protect against STDs or HIV, and potential risks include ectopic pregnancy. A consent form is required before receiving the injections.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and date of birth in the designated fields. This information is essential for identifying your medical records.
Review the fact sheet provided on Depo-Provera carefully. Ensure you understand the risks, benefits, and possible side effects associated with the injection.
Check the box indicating that you have reviewed the fact sheet and that your questions have been answered satisfactorily.
Fill in your phone number and any other required contact information to facilitate communication regarding your appointment.
Sign the form where indicated to provide your consent for receiving Depo-Provera injections.
Finally, ensure that a nurse also signs the form, confirming that all necessary information has been communicated.

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