Consent to Physical Intimacy Form
This form documents mutual agreement and informed consent between adults regarding physical intimacy.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Partner's Full Name
*
First Name
Last Name
Partner's Email Address
*
example@example.com
Partner's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Agreement
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Are both parties at least 18 years old and willingly participating?
*
Yes, both parties are at least 18 and are participating willingly.
No
Are there any boundaries, limitations, or preferences you would like to state?
Emergency Contact (Name and Phone Number)
Signature of First Party
*
Signature of Second Party
*
Submit Consent
Submit Consent
Should be Empty: