--- title: Geriatric Assessment Consent Form Template | Paperform description: Professional geriatric assessment consent form with cognitive screening, fall risk evaluation, medication review, and HIPAA-compliant care coordination authorization for senior healthcare. url: "https://paperform.co/templates/geriatric-assessment-consent-form" type: static generatedAt: "2026-04-04T00:44:05.691Z" --- [← Back to free form templates](/templates/) ![Geriatric Assessment Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/geriatric-assessment-consent-form.png) [Preview](https://_preview.paperform.co/ai-template/geriatric-assessment-consent-form) [Use this template for free](/create?ai-template=geriatric-assessment-consent-form) [Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/) About this free form template A geriatric assessment is a multidimensional, interdisciplinary diagnostic process designed to evaluate an older person's functional ability, physical health, cognitive and mental health, and socioenvironmental circumstances. This comprehensive assessment form streamlines the consent process for healthcare providers working with elderly patients. This geriatric assessment consent form template covers all critical areas of senior care evaluation, including cognitive function screening, fall risk assessment, comprehensive medication review, and authorization for care coordination with specialists. Healthcare providers can gather essential patient information, medical history, and proper consent documentation in one streamlined process. Designed for geriatricians, primary care physicians, senior care facilities, and healthcare organizations serving elderly populations, this template ensures compliance with HIPAA regulations while collecting vital information for accurate patient assessment. The form includes sections for patient demographics, emergency contacts, current health status, medication inventory, cognitive screening consent, fall risk evaluation authorization, and care coordination permissions. By using Paperform's conditional logic, the form adapts based on patient responses, ensuring only relevant questions are displayed. Healthcare teams can collect eSignatures through [Papersign](https://papersign.com) for legally binding consent documentation, and automate follow-up workflows using [Stepper](https://stepper.io) to coordinate with specialists, schedule assessments, and trigger appropriate care protocols. This template helps healthcare providers deliver person-centered care while maintaining thorough documentation, improving patient outcomes, and ensuring seamless communication across the care team. Whether you're conducting initial geriatric assessments, annual wellness visits, or post-hospitalization evaluations, this form provides a professional foundation for comprehensive senior care. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Hospice Care Admission and Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-admission-and-consent-form.png) ### Hospice Care Admission and Consent Form A comprehensive hospice care admission form to collect patient information, treatment consent, DNR preferences, pain management options, HIPAA authorization, and end-of-life care decisions with family notification settings.](/templates/hospice-care-admission-and-consent-form/) [![Healthcare Proxy Declaration Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-proxy-declaration-form.png) 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