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Progestin-Only Oral Contraceptive, Consent Form, 2017

Progestin-Only Oral Contraceptive, Consent Form, 2017-2026

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This document is a consent form for women requesting birth control pills as a family planning method. It outlines the benefits and risks associated with the Pill, including potential side effects, interactions with other medications, and health conditions that may increase risks. The form emphasizes the importance of understanding that no contraceptive method is foolproof and highlights the need for additional protection against sexually transmitted infections. It also includes a section for translation services if needed.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the designated field at the top of the form. This personalizes your consent and ensures clarity.
Review the information provided about the benefits and risks of birth control pills. Acknowledge that you have received a pamphlet by checking the appropriate box.
Indicate your understanding of potential interactions with other medications and health conditions by reading through the listed items carefully.
Sign and date the form at the bottom to confirm your consent and understanding of all information presented.
If applicable, complete the translation section if you required assistance in understanding this document.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can a 15 year old get birth control without parental consent?

A minipill (progestin-only pill or POP) is a form of birth control you take by mouth each day to prevent pregnancy. It contains progestin, a man-made (synthetic) version of the hormone progesterone. Unlike other forms of birth control pills that contain both estrogen and progestin, the minipill contains just progestin.

Do you need a prescription for progestin-only pills?

Can I get progestin-only pills without a prescription? In the United States, one type of progestin-only pill is available without a prescription (over-the-counter) in many pharmacies and online. It is safe and effective, and it can be a good option for many people.

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