[Provider] Sterilization Consent Forms

[Provider Notification]

ATTENTION: Providers who use Sterilization Consent Forms 

 

The Sterilization Consent form is available on line at
http://www.hhs.gov/forms/HHS-687.pdf .  You can fill out the form
electronically, and then print for wet signatures.  You can also save it
to your local computer drive.  

 

We encourage you to use this on-line form.  If you do not have on-line
access, you may call GHS at 207-622-7153 and request paper forms.  

 

Quick Reminder: A Sterilization Consent form is good for 180 days from
the date it is signed.  If the consent is already 180 days old, the
patient should sign a new one.  The procedure should occur at least 30
days after the patient signs.   

 

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