Informed consent for external-beam radiation therapy or brachytherapy, including site-specific acute and late toxicities, treatment planning, and fertility considerations. Single signer (patient).
The Radiation Therapy Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, oncology, radiation, radiotherapy, cancer, toxicity. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Radiation Therapy Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Date:** ___________ **Radiation Oncology Department / Cancer Center:** ___________ **Treating Radiation Oncologist:** ___________ **Medical Physicist / Dosimetrist (for record):** ___________ **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ --- ## 1. Diagnosis and Treatment Plan **Cancer diagnosis:** ___________ **Disease stage / extent:** ___________ **Radiation modality:** ___________ **Treatment site / target volume:** ___________ **Total planned dose:** ___________ (e.g., 45 Gy in 25 fractions) **Fractions per week:** ___________ **Estimated total treatment duration:** ___________ **Treatment intent:** ___________ ---