Young Person Blood Test Consent Form

This consent form for a blood test is a document that asks for your permission before having a small sample of your blood taken. It's like giving a 'green light' for the test to happen. By signing it, you're saying that you understand what the test is for, how it will be done, and that you agree to go ahead with it. It's a way to make sure you're comfortable with the procedure and that you're involved in decisions about your healthcare.

Name

First NameLast Name

Email

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Date of Birth

Date

Which blood tests have you been advised to have?

Estradiol (also called estrogen, oestrogen, oestradiol - the feminising hormone)Testosterone (the masculinising hormone)Potassium (for people taking spironolactone - part of a kidney test)Haematocrit (checking for the size of your red blood cells)

Finger Prick Blood Tests

Think of it like this: it's a quick test to check what's going on inside your body. You or a responsible adult will use a small, sharp tool to prick your finger, sort of like a tiny pinprick. You might feel a quick sting, but it's not too bad.

Then, a drop of your blood comes out, like when you get a paper cut. They collect that drop in a little container and send it to the laboratory.

They'll put a band-aid on your finger afterward, and you're good to go. It's a simple test that helps get important information about your health. It's over before you know it!

Venous (Vein) Blood Tests

Getting a venous blood test is a bit like a superhero mission for your body! It's a special test where a nurse or technician will use a tiny needle to draw a small amount of blood from one of your veins, usually in your arm.

First, they'll wrap a stretchy band around your arm to help your veins stand out, like a superhero's cape. Then, they'll clean the area with a cool swab to keep everything super clean.

When it's time for the needle, you might feel a quick sting, like a mosquito bite. But don't worry, it's over in a flash, and most people say it's not too bad.

The blood they collect goes into special tubes, like treasure chests for your blood. They'll send these tubes to a lab where experts can check your blood for all sorts of important things to make sure you're healthy.

Afterward, you might get a cool superhero band-aid, and you're free to go! It's a brave thing to do, and it helps you take care of your health to keep you feeling your best.

Spironolactone Blood Tests

When teenagers take Spironolactone, a medication that can help with certain health conditions, it's important for doctors to keep an eye on something called 'potassium levels' in their bodies. Potassium is like a special ingredient our bodies need to work properly.

Spironolactone can sometimes affect how much potassium your body holds onto, and too much or too little potassium isn't good for us. So you can have a simple blood test to check the amount of potassium in your blood.

Don't worry, it's a quick and painless test. You'll just need to give a small blood sample, usually from a finger prick or a regular blood draw. The sample is then sent to a lab to measure your potassium levels.

By checking your potassium levels regularly, you can make sure you're taking the right dose of Spironolactone and that your body is staying healthy. It's just one of the ways of looking out for your wellbeing while you're on this medication.

Haematocrit Blood Tests

When you take testosterone as a medication, it's important to monitor something called 'hematocrit levels' in your blood. Hematocrit is like a superhero in your blood, carrying oxygen to your body's cells.

Testosterone can sometimes increase the number of red blood cells in your blood, which is a bit like having too many superheroes. If there are too many red blood cells, it can make your blood thicker, and that's not good for your health.

To keep an eye on this, you can do a simple blood test. You'll need to give a small sample of your blood, usually from a finger prick or a regular blood draw. Then, you can measure your hematocrit levels in a lab.

Checking your hematocrit levels regularly helps make sure you're on the right dose of testosterone and that your blood is staying healthy. It's just one way they look out for your wellbeing while you're on this treatment.

Hormone Levels

When teenagers are taking gender-affirming hormones, it's important to keep an eye on their hormone levels. These hormones are the things that help your body align with your true gender.

You can do blood tests to check these hormone levels regularly. It's a bit like checking the fuel levels in a car to make sure it's running smoothly. The tests help you make sure you're getting the right amount of hormones.

You'll give a small blood sample, usually from a finger prick or a regular blood draw, and then send it to a lab for testing. This helps you see if your hormone levels are in a healthy range and if any adjustments to your treatment are needed.

Checking hormone levels is an important part of your transition journey and it helps you make sure you're safe and well throughout the process.

Statement of Consent

I hereby confirm that I understand the details regarding the upcoming blood test, including its purpose, the procedure for its collection, and the handling of the results. I have had the opportunity to ask any questions I may have had, and all of my inquiries have been answered to my satisfaction.

Specifically:

1. I understand that the blood test is being conducted to monitor my hormone levels and other important blood levels as part of my medical transition process.

2. I am aware that the blood test will involve the collection of a small sample of blood, either through either a venous blood draw or finger prick.

3. I know that the results of this blood test will be used to adjust my medication if necessary and ensure that my healthcare needs are met.

4. I have no further questions or concerns at this time regarding the blood test or its associated procedures.

By providing my consent, I affirm that I am fully informed about the blood test, its purpose, and the handling of its results, and I am willingly proceeding with the test.

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