Research • Policy • Practice

Sample Form: Consent Forms

Luzerne Consent Form

This consent form is used to allow the Luzerne County Treatment Court to retain information regarding a participant’s case following expungement of his/her charges if granted.

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Informed Consent for Acupuncture Treatment

INFORMED CONSENT FOR ACUPUNCTURE TREATMENT. I voluntarily consent to receive acupuncture treatment provided by a California licensed acupuncturist employed with the Community Acupuncture Recovery Association (C.A.R.A).

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Consent for Release of Confidential Information

This document is a consent form for participants releasing information t Tulsa County’s treatment courts.

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Multiparty Case Staffings and Open Court Hearings Consent Form

This is a consent form for the Tulsa Veterans Treatment Court and Drug/DUI Court that grants court staff access to participant information.

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Piedmont Judicial Circuit Felony Drug Court Program Consent for Release/Disclosure of Information

This document contains consent forms for release of information.

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Benton County Authorization Form (Disclosure of Photographs)

This form is used to authorize the use of photographs and information for events related to the Benton County Drug Court program.

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Philadelphia Treatment Patient Consent Form

This form is used to obtain consent in order to be able to share protected treatment information.

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