Please review the following attached paperwork before beginning any MDC event. This paperwork will be included in your tote. Please do not print as these are just for review. This ensures that all paperwork is completed accurately before the end of each MDC event. Faculty is responsible for the accuracy of this paperwork and all items are to be completed/returned to the MDC Closet or MDC Coordinator immediately after event closing.
These forms are carbon copy. The white copy is for the client and the pink copy is for our records. The white copy has patient information on it and should be treated with care while in our possession. Since clients will be given back the white copy of the form, no faculty/staff or student should be in possession of personal health information at any time post event.
Please have the client fill out the consent form and personal information through family history. The additional questions will be asked by the faculty/staff and students throughout the screening process. The lead faculty will close out the encounter with the client and ensure all of the form is filled out. Please give the white copy to the client and show them the "understanding your results" on the back side.
If you have questions, please contact Kiley Petersmith or Andrea Peak.
MDC Screening Consent Form-English
MDC Screening Consent Form-Spanish