Copper T IUD Consent Form DHHS 4103 - Womens Health Branch - www2 columbusco-2026

1. Begin by clicking ‘Get Form’ to open the Copper T IUD Consent Form in our editor.
2. Fill in your Last Name, First Name, and Middle Initial in the designated fields at the top of the form.
3. Enter your Patient Number and Date of Birth in the specified format (MM/DD/YYYY).
4. Select your Race and Ethnic Origin from the provided checkboxes to ensure accurate demographic information.
5. Indicate your Gender and County of Residence as required.
6. Read through the Voluntary Participation and Confidentiality Statement carefully, ensuring you understand your rights regarding family planning services.
7. Review the benefits, risks, and side effects associated with the Copper T IUD. Make sure you are informed before proceeding.
8. Sign and date the form at the bottom to confirm your consent for using the Copper T IUD as a birth control method.

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