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Name Size/Type Description Date
Ipilimumab & Nivolumab consent 113KB PDF Ipilimumab & Nivolumab consent 21 Apr 2020
Ipilimumab & Nivolumab mesothelioma consent 291KB PDF Ipilimumab + Nivolumab mesothelioma consent 28 Feb 2024
Ipilimumab consent 112KB PDF Ipilimumab consent 21 Apr 2020
Irinotecan consent 112KB PDF Irinotecan consent 21 Apr 2020
Irinotecan MdG (Folfiri) consent 115KB PDF Folfiri consent 01 Dec 2020
Ivosidenib consent 113KB PDF Ivosidenib consent 28 Feb 2024
Kadcyla (Trastuzumab emtansine) consent 112KB PDF Kadcyla consent 05 Jun 2020
Larotrectinib consent 111KB PDF Larotrectinib consent 22 Dec 2020
Lenvatinib (Lenvima) consent 113KB PDF Lenvatinib (Lenvima) consent 21 Apr 2020
Lomustine consent 110KB PDF Lomustine consent 21 Apr 2020
Lorlatinib consent 112KB PDF Lorlatinib consent 05 Jun 2020
Mobocertinib consent 112KB PDF Mobocertinib consent 31 May 2022
Modified de Gramont consent 115KB PDF modified de gramont consent 01 Dec 2020
Neratinib & Capecitabine consent 156KB PDF Neratinib & Capecitabine consent 30 Jun 2020
Neratinib consent 152KB PDF Neratinib consent 30 Jun 2020
Niraparib consent 109KB PDF Niraparib consent 21 Apr 2020
Nivolumab consent 112KB PDF Nivolumab consent 21 Apr 2020
Nivolumab relatlimab (opdualag) consent 110KB PDF Nivolumab relatlimab (opdualag) consent 25 Apr 2024
Olaparib + Bevacizumab consent 111KB PDF Olaparib + Bevacizumab consent 13 Apr 2021
Olaparib consent 112KB PDF Olaparib consent 28 Apr 2023
Osimertinib consent 110KB PDF Osimertinib consent 04 Feb 2021
Oxaliplatin + Capecitabine consent 138KB PDF Oxaliplatin + Capecitabine consent 01 Dec 2020
Oxaliplatin MdG (Folfox) consent 117KB PDF Oxaliplatin MdG (Folfox) consent 01 Dec 2020
Paclitaxel (weekly) consent 112KB PDF Paclitaxel (weekly) consent 21 Apr 2020
Paclitaxel & Carboplatin consent 134KB PDF Paclitaxel & Carboplatin consent 21 Apr 2020
Paclitaxel & carboplatin, EC with pembrolizumab consent 118KB PDF Paclitaxel & carboplatin, EC with pembrolizumab consent 23 Dec 2022
Paclitaxel & Cisplatin consent 113KB PDF Paclitaxel & Cisplatin consent 21 Apr 2020
Paclitaxel & Gemcitabine consent 113KB PDF Paclitaxel & Gemcitabine consent 21 Apr 2020
Paclitaxel, Carboplatin & Epirubicin (TEC) consent 113KB PDF Paclitaxel, Carboplatin & Epirubicin (TEC) consent 21 Apr 2020
Palbociclib consent 112KB PDF Palbociclib consent 21 Apr 2020

Chemotherapy Consent Forms for Solid Tumours

All consent forms on this website are for the use of St Luke’s Cancer Alliance staff in respect of St Luke’s Cancer Alliance patients only.
For those who do not work within St Luke’s Cancer Alliance:
Use of this site and any information on it is at your own risk. We do not accept responsibility for the use of any information that may be set out on the website. You assume full responsibility for the use of the information.  You may wish to take your own legal advice before using any of the consent forms.

Please note that the consent forms below are not tumour-specific; one consent form may be used to consent patients for more than one St Luke’s Alliance chemotherapy protocol which uses the same combination of chemotherapy.

These consent forms should act as an aide-memoire to health professionals and patients, by providing a check-list of the kind of information which patients should be offered, and by enabling the patient to have a written record of the main points discussed.

The relevant Macmillan leaflet(s) should also be provided to each patient before consent. In no way should written information given to the patient be regarded as a substitute for face-to-face discussions with the patient.

These consent forms are for solid tumour chemotherapy only, and are NOT to be used for chemo-radiotherapy regimens.