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Washington consent form 2026

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  1. Click ‘Get Form’ to open the Washington Consent Form in the editor.
  2. Begin by filling out the CLIENT IDENTIFICATION section. Enter your NAME, DATE OF BIRTH, ADDRESS, IDENTIFICATION NUMBER, CITY, STATE, ZIP CODE, and TELEPHONE NUMBER. Ensure all information is accurate for proper identification.
  3. In the CONSENT section, indicate your agreement to share confidential information by checking the appropriate boxes for agencies and individuals listed. Be sure to include any specific names and addresses as required.
  4. Specify which records you authorize for sharing by checking all applicable boxes under 'I authorize and consent to sharing the following records and information.' This may include health care information or treatment plans.
  5. Complete the duration of consent by selecting either 'one year' or specifying a date/event. Remember that you can revoke this consent at any time in writing.
  6. Finally, sign and date the form. If applicable, have a parent or representative sign as well. Ensure that all signatures are witnessed if necessary.

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Related links

Consent and HIPAA Templates - UW Research

The UW IRB provides the UW research community with a variety of consent templates that align with regulatory and policy requirements and best practices

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Consent

By signing this form, you are giving permission for DSHS and the agencies and individuals listed below to use and share confidential information about you.

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