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Midwife Mirena IUD Consent Mobile App

Every person should be encouraged to exercise the right to participate in making decisions that will affect their current fertility as well as their future health. Please have patients read the items in the app to acknowledge that they give informed consent (permission) to perform the indicated procedure. The Mirena IUD is highly effective, safe method, no estrogen (reduced risk of endometrial cancer) long term protection, rapid reversibility, cost-effective, convenient, private, easy placement and removal, high user satisfaction. Use the Midwife Mirena IUD Consent mobile app to allow women to consent to the insertion of a Merina IUD.

GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Midwife Mirena IUD Consent Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    We at <Insert Name> believe that every person should be encouraged to exercise the right to parti...

  • Ico statictext

    Highly effective, safe method, no estrogen (reduced risk of endometrial cancer) long term protect...

  • Ico statictext

    I have been counseled regarding the risks/benefits/alternatives of IUD’s such as oral contracepti...

  • Ico statictext

    I understand the insertion procedure involved a pelvic exam to determine the position of my uteru...

  • Ico statictext

    I will contact my healthcare provider immediately with any of the following: P – Period late, abn...

  • Ico statictext

    I certify that this form has been fully explained to me, that I have read it or have had it read ...

  • Ico textbox

    Client Name

  • Ico signature

    Signature

  • Ico date

    Date

  • Ico textbox

    CNM/RN Name

  • Ico signature

    Signature

  • Ico date

    Date

  • ...and More!

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