Documents

Folders (1)

Name Files
PICC Consent Form 1

Files(23)

Name Size/Type Description Date
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
Panitumumab + Irinotecan MdG consent 116KB PDF Panitumumab + Folfiri consent 01 Dec 2020
Panitumumab + Oxaliplatin MdG (Folfox) consent 117KB PDF Panitumumab + Folfox consent 01 Dec 2020
Panitumumab consent 114KB PDF Panitumumab consent 07 Jun 2023
Pazopanib consent 111KB PDF Pazopanib consent 21 Apr 2020
PCV Consent 112KB PDF PCV Consent 21 Apr 2020
Pembrolizumab + Abraxane consent 118KB PDF Pembrolizumab + Abraxane consent 29 Jul 2022
Pembrolizumab consent 85KB PDF Pembrolizumab consent 30 Jan 2025
Pembrolizumab, Paclitaxel & Carboplatin consent 142KB PDF Pembrolizumab, Paclitaxel & Carboplatin consent 28 Apr 2023
Pembrolizumab, Pemetrexed & Carboplatin consent 117KB PDF Pembrolizumab, Pemetrexed & Carboplatin consent 21 Apr 2020
Pembrolizumab, Pemetrexed & Cisplatin consent 117KB PDF Pembrolizumab, Pemetrexed & Cisplatin consent 21 Apr 2020
Pemetrexed & Carboplatin consent 112KB PDF Pemetrexed & Carboplatin consent 21 Apr 2020
Pemetrexed & Cisplatin consent 113KB PDF Pemetrexed & Cisplatin consent 21 Apr 2020
Pemetrexed consent 111KB PDF Pemetrexed consent 21 Apr 2020
Pemigatinib consent 114KB PDF Pemigatinib consent 02 Aug 2021
Pertuzumab & Trastuzumab (Phesgo) consent 139KB PDF pertuzumab + trastuzumab (phesgo) consent 26 Feb 2021
PICC consent 98KB PDF PICC 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.