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(Legal Question) How would I include this form into a legal document prepared for the court?

Let’s say that I am preparing a document (memo, brief, whatever) for the court. I want to include the following consent form: Form

Procedurally and legally, how would I go about including that form in my document? (i.e. I am not looking for an answer like “cut and paste”) Is there a certain citation format I need to use? Is the form even admissible in a court of law?

P.S. For all intents and purposes, assume that the form is relevant to my case.

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