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Camera Number___Participant ID Code: ___**Administrative Use Only**Florida Lions Diabetic Retinopathy Foundation Retina Screening Consent Form Please Print Clearly. Please complete the entire form

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Obtain the consent form from the organization requesting it.

02

Read the form thoroughly and make sure you understand all the information it contains.

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Fill out all required personal information, such as name, address, date of birth, etc.

04

Clearly indicate your consent by signing and dating the form.

05

If applicable, have a witness sign the form as well.

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Leave any sections that do not apply to you blank.

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Return the completed form to the organization according to their instructions.

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Anyone who is required to give permission or approval for a specific activity, treatment, event, or any other purpose may need to fill out a consent form.

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What is consent form - about?

Consent form is a document that confirms the agreement or permission of an individual to participate in a certain activity or provide certain information.

Who is required to file consent form - about?

Anyone who is seeking consent from an individual for a specific purpose is required to file a consent form.

How to fill out consent form - about?

A consent form should be filled out by providing relevant information about the purpose of consent, the individual providing consent, and any additional details required for the specific activity.

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The purpose of a consent form is to ensure that individuals are informed about and agree to participate in certain activities or provide certain information.

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The consent form should include details about the purpose of consent, the individual providing consent, any limitations on the consent, and any specific requirements for the activity.

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