diff --git a/.env.example b/.env.example
index 6669464..03eec9b 100644
--- a/.env.example
+++ b/.env.example
@@ -85,4 +85,9 @@ USE_AWS_SECRETS=false
 AWS_SECRET_NAME=
 
 # AWS region for Secrets Manager (default: us-east-1)
-AWS_REGION=us-east-1
\ No newline at end of file
+AWS_REGION=us-east-1
+
+# ── Patient consent ───────────────────────────────────────────────────────────
+# Set to 'false' to waive consent requirement (e.g. jurisdiction config).
+# Default: true (consent required before minting)
+REQUIRE_PATIENT_CONSENT=true
diff --git a/backend/src/indexer/db.js b/backend/src/indexer/db.js
index 5d23a2c..866cbeb 100644
--- a/backend/src/indexer/db.js
+++ b/backend/src/indexer/db.js
@@ -28,6 +28,11 @@ const SCHEMA = `
     created_at  TEXT NOT NULL,
     revoked     INTEGER NOT NULL DEFAULT 0
   );
+
+  CREATE TABLE IF NOT EXISTS patient_consent (
+    wallet       TEXT PRIMARY KEY,
+    consented_at TEXT NOT NULL
+  );
 `;
 
 /** Persist in-memory DB to disk. */
@@ -139,4 +144,27 @@ function revokeApiKey(id) {
   flush();
 }
 
-module.exports = { initDb, upsertEvents, queryEvents, getLatestLedger, insertApiKey, getApiKeyByHash, listApiKeys, revokeApiKey };
+module.exports = { initDb, upsertEvents, queryEvents, getLatestLedger, insertApiKey, getApiKeyByHash, listApiKeys, revokeApiKey, getConsent, recordConsent, hasConsented };
+
+// ── Patient consent ───────────────────────────────────────────────────────────
+
+function recordConsent(wallet) {
+  db.run(
+    'INSERT OR IGNORE INTO patient_consent (wallet, consented_at) VALUES (?, ?)',
+    [wallet, new Date().toISOString()]
+  );
+  flush();
+}
+
+function getConsent(wallet) {
+  const res = db.exec('SELECT wallet, consented_at FROM patient_consent WHERE wallet = ?', [wallet]);
+  if (!res.length) return null;
+  const { columns, values } = res[0];
+  const obj = {};
+  columns.forEach((col, i) => { obj[col] = values[0][i]; });
+  return obj;
+}
+
+function hasConsented(wallet) {
+  return !!getConsent(wallet);
+}
diff --git a/backend/src/routes/consent.js b/backend/src/routes/consent.js
new file mode 100644
index 0000000..9225e7c
--- /dev/null
+++ b/backend/src/routes/consent.js
@@ -0,0 +1,30 @@
+const express = require('express');
+const authMiddleware = require('../middleware/auth');
+const { getConsent, recordConsent, hasConsented } = require('../indexer/db');
+
+const router = express.Router();
+
+/**
+ * GET /patient/consent/:wallet
+ * Returns consent status for a wallet. Public — used by issuers before minting.
+ */
+router.get('/consent/:wallet', (req, res) => {
+  const { wallet } = req.params;
+  const consent = getConsent(wallet);
+  res.json({ wallet, consented: !!consent, consented_at: consent?.consented_at ?? null });
+});
+
+/**
+ * POST /patient/consent
+ * Record explicit patient consent. Requires patient JWT.
+ */
+router.post('/consent', authMiddleware, (req, res) => {
+  const { publicKey } = req.user;
+  if (getConsent(publicKey)) {
+    return res.json({ success: true, wallet: publicKey, already_consented: true });
+  }
+  recordConsent(publicKey);
+  res.status(201).json({ success: true, wallet: publicKey });
+});
+
+module.exports = router;
diff --git a/backend/src/routes/vaccination.js b/backend/src/routes/vaccination.js
index 3da9df1..4296261 100644
--- a/backend/src/routes/vaccination.js
+++ b/backend/src/routes/vaccination.js
@@ -7,6 +7,7 @@ const { validateStellarPublicKey } = require('../middleware/wallet');
 const { invokeContract, simulateContract } = require('../stellar/soroban');
 const { audit } = require('../middleware/auditLog');
 const validate = require('../middleware/validate');
+const { hasConsented } = require('../indexer/db');
 
 const router = express.Router();
 
@@ -98,6 +99,11 @@ router.post(
   async (req, res) => {
   const { patient_address, vaccine_name, date_administered, dose_number, dose_series } = req.body;
 
+  // Enforce patient consent unless jurisdiction config waives it
+  if (process.env.REQUIRE_PATIENT_CONSENT !== 'false' && !hasConsented(patient_address)) {
+    return res.status(403).json({ error: 'Patient has not provided consent. They must consent before a record can be issued.' });
+  }
+
   try {
     const toOptU32 = (v) => v != null
       ? StellarSdk.xdr.ScVal.scvVec([StellarSdk.xdr.ScVal.scvU32(v)])
diff --git a/frontend/src/components/ConsentScreen.jsx b/frontend/src/components/ConsentScreen.jsx
new file mode 100644
index 0000000..6207e9e
--- /dev/null
+++ b/frontend/src/components/ConsentScreen.jsx
@@ -0,0 +1,78 @@
+import { useState } from 'react';
+
+const s = {
+  overlay: {
+    position: 'fixed', inset: 0, background: 'rgba(0,0,0,0.7)',
+    display: 'flex', alignItems: 'center', justifyContent: 'center',
+    zIndex: 1000, padding: '1rem',
+  },
+  modal: {
+    background: '#1e293b', borderRadius: 12, padding: '2rem',
+    maxWidth: 520, width: '100%', color: '#e2e8f0',
+  },
+  title: { fontSize: '1.25rem', fontWeight: 700, marginBottom: '1rem', color: '#38bdf8' },
+  body: { fontSize: '0.9rem', lineHeight: 1.6, color: '#94a3b8', marginBottom: '1.25rem' },
+  list: { paddingLeft: '1.25rem', marginBottom: '1.25rem', color: '#94a3b8', fontSize: '0.9rem', lineHeight: 1.8 },
+  checkRow: { display: 'flex', alignItems: 'flex-start', gap: '0.75rem', marginBottom: '1.5rem' },
+  checkLabel: { fontSize: '0.9rem', color: '#e2e8f0', cursor: 'pointer' },
+  btnRow: { display: 'flex', gap: '0.75rem', justifyContent: 'flex-end' },
+  btnAccept: { padding: '0.6rem 1.5rem', background: '#0ea5e9', color: '#fff', border: 'none', borderRadius: 8, cursor: 'pointer', fontWeight: 600 },
+  btnDecline: { padding: '0.6rem 1.5rem', background: 'transparent', color: '#94a3b8', border: '1px solid #334155', borderRadius: 8, cursor: 'pointer' },
+};
+
+/**
+ * ConsentScreen — shown to first-time patients before their wallet is associated
+ * with on-chain vaccination records.
+ *
+ * Props:
+ *   onAccept()  — called when patient accepts; caller should POST /v1/patient/consent
+ *   onDecline() — called when patient declines
+ *   loading     — disables the accept button while the consent POST is in flight
+ */
+export default function ConsentScreen({ onAccept, onDecline, loading = false }) {
+  const [checked, setChecked] = useState(false);
+
+  return (
+    <div style={s.overlay} role="dialog" aria-modal="true" aria-labelledby="consent-title">
+      <div style={s.modal}>
+        <h2 id="consent-title" style={s.title}>💉 Data Consent</h2>
+        <p style={s.body}>
+          Before your vaccination records can be issued, you must understand what data is stored
+          and who can access it.
+        </p>
+        <ul style={s.list}>
+          <li>Your <strong>Stellar wallet address</strong> is stored on a public blockchain.</li>
+          <li>Vaccination records (vaccine name, date, issuer) are <strong>publicly visible</strong> to anyone who queries the contract.</li>
+          <li>Records are <strong>permanent and cannot be deleted</strong> — only revoked by an authorized issuer.</li>
+          <li>Your consent timestamp and wallet address are stored off-chain by VacciChain.</li>
+        </ul>
+        <div style={s.checkRow}>
+          <input
+            id="consent-check"
+            type="checkbox"
+            checked={checked}
+            onChange={(e) => setChecked(e.target.checked)}
+            aria-required="true"
+          />
+          <label htmlFor="consent-check" style={s.checkLabel}>
+            I understand and consent to my vaccination data being stored on the Stellar blockchain.
+          </label>
+        </div>
+        <div style={s.btnRow}>
+          <button style={s.btnDecline} onClick={onDecline} type="button">
+            Decline
+          </button>
+          <button
+            style={{ ...s.btnAccept, opacity: (!checked || loading) ? 0.5 : 1 }}
+            onClick={onAccept}
+            disabled={!checked || loading}
+            aria-disabled={!checked || loading}
+            type="button"
+          >
+            {loading ? 'Recording…' : 'I Consent'}
+          </button>
+        </div>
+      </div>
+    </div>
+  );
+}
diff --git a/frontend/src/hooks/useConsent.js b/frontend/src/hooks/useConsent.js
new file mode 100644
index 0000000..cc6fafa
--- /dev/null
+++ b/frontend/src/hooks/useConsent.js
@@ -0,0 +1,55 @@
+import { useState, useCallback } from 'react';
+import { useAuth } from './useFreighter';
+
+/**
+ * useConsent — manages patient consent state.
+ *
+ * Returns:
+ *   consented      — null (unknown), true, or false
+ *   checkConsent() — fetch consent status for the connected wallet
+ *   giveConsent()  — POST consent and update state
+ *   loading        — true while a request is in flight
+ */
+export function useConsent() {
+  const { publicKey, apiFetch } = useAuth();
+  const [consented, setConsented] = useState(null);
+  const [loading, setLoading] = useState(false);
+
+  const checkConsent = useCallback(async (wallet) => {
+    if (!wallet) return;
+    setLoading(true);
+    try {
+      const res = await apiFetch(`/v1/patient/consent/${wallet}`);
+      const data = await res.json();
+      setConsented(data.consented);
+      return data.consented;
+    } catch {
+      return null;
+    } finally {
+      setLoading(false);
+    }
+  }, [apiFetch]);
+
+  const giveConsent = useCallback(async () => {
+    if (!publicKey) return false;
+    setLoading(true);
+    try {
+      const res = await apiFetch('/v1/patient/consent', {
+        method: 'POST',
+        headers: { 'Content-Type': 'application/json' },
+        body: JSON.stringify({ wallet: publicKey }),
+      });
+      if (res.ok) {
+        setConsented(true);
+        return true;
+      }
+      return false;
+    } catch {
+      return false;
+    } finally {
+      setLoading(false);
+    }
+  }, [publicKey, apiFetch]);
+
+  return { consented, checkConsent, giveConsent, loading };
+}
diff --git a/frontend/src/pages/PatientDashboard.jsx b/frontend/src/pages/PatientDashboard.jsx
index ef907d2..5c2b768 100644
--- a/frontend/src/pages/PatientDashboard.jsx
+++ b/frontend/src/pages/PatientDashboard.jsx
@@ -7,6 +7,7 @@ import NFTCardSkeleton from '../components/NFTCardSkeleton';
 import RecordDetailModal from '../components/RecordDetailModal';
 import CopyButton from '../components/CopyButton';
 import QRCodeModal from '../components/QRCodeModal';
+import ConsentScreen from '../components/ConsentScreen';
 
 const PAGE_LIMIT = 20;
 
@@ -25,6 +26,7 @@ export default function PatientDashboard() {
   const { t } = useTranslation();
   const { publicKey, connect } = useAuth();
   const { fetchRecords, loading } = useVaccination();
+  const { consented, checkConsent, giveConsent, loading: consentLoading } = useConsent();
   const [records, setRecords] = useState([]);
   const [total, setTotal] = useState(0);
   const [page, setPage] = useState(1);
@@ -63,6 +65,19 @@ export default function PatientDashboard() {
     );
   }
 
+  // Show consent screen for first-time patients (consented === false means checked and not yet consented)
+  if (consented === false) {
+    return (
+      <div style={styles.page}>
+        <ConsentScreen
+          onAccept={giveConsent}
+          onDecline={handleDeclineConsent}
+          loading={consentLoading}
+        />
+      </div>
+    );
+  }
+
   return (
     <div style={styles.page}>
       <div style={{ display: 'flex', flexWrap: 'wrap', justifyContent: 'space-between', alignItems: 'baseline', gap: '0.5rem', marginBottom: '1.5rem' }}>