Phenylketonuria (PKU) Screening Consent

Patient Information

Patient Name Date of Birth

Parent/Guardian Information (if applicable)

Parent/Guardian Name

Consent Statement

I have been informed about the purpose and nature of Phenylketonuria (PKU) screening. I understand that this screening is a simple blood test performed to detect PKU, a rare inherited disorder. I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction.

I understand that participation in this screening is voluntary, and I may withdraw my consent at any time before the screening is performed.

By signing below, I give my consent for PKU screening to be performed.