Medication consent

Informed Consent for Treatment with Cosentyx (secukinumab)

Informed consent for treatment with Cosentyx.

About this form

Cosentyx (secukinumab) is approved for plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. It targets interleukin-17A (IL-17A), a cytokine central to inflammation in these conditions.

!Increased risk of infections, including serious or fatal infections.
!TB testing is required prior to therapy; do not start with active infection.
!May cause inflammatory bowel disease flares (Crohn's, ulcerative colitis).
!Severe hypersensitivity / allergic reactions can occur.

Progress

Benefits

I understand that the potential benefits of this treatment include: *

Improves skin clearance in plaque psoriasis and reduces joint pain in PsA / AS.Demonstrated long-term efficacy and safety profile.

Common side effects

I have been informed of the most common side effects, which include: *

Cold-like symptomsDiarrheaUpper respiratory infectionsInjection-site reactions

Acknowledgements

I have had the opportunity to discuss this treatment with my physician. *

Yes — I have had this opportunity

All of my questions have been answered to my satisfaction. *

Yes — my questions have been answered

I understand my financial responsibility for this treatment. *

Yes — I understand

Any additional questions or notes for our team

Sign & submit

Patient name *Date of birth *Email address *Patient signature (type your full name) *Date *

Acknowledgement. I certify that I have read and understood this consent form, that I have had the opportunity to discuss it with my physician, and that I agree to receive treatment with Cosentyx (secukinumab).

Submitting transmits this form securely to our office. For urgent medical issues please call our office or 911.

Trouble with the form?

Call our office and we'll either walk you through it or send a paper version.

Call (916) 677-4744 ← All forms