Sample Telehealth Consent Form for Private Practices

Be compliant with telehealth regulations by having your client sign a telehealth consent form.

Telehealth in the United States is currently affected by laws and regulations at the federal and state levels. Currently, there is no uniform legal approach to telehealth nutrition. Telehealth laws and regulations are still determined by each state government, which continues to be a major challenge in its provision.

A “Telehealth Informed Consent Form” explains the virtual services that you provide, as well as the risks and benefits associated with care provided via telehealth. Essentially, it ensures that the patient understands how care will be provided virtually, and any perceivable limitations associated with a virtual (versus in-person) session.

Depending on your state, receiving a telehealth informed consent form may be required for your profession (regulations vary by profession, depending on state regulations).

Within this guide, there are several suggestions on what to provide within a Telehealth consent form, including:

  • Inform patients of their rights when receiving telemedicine, including the right to suspend or refuse treatment
  • Inform patients of their own responsibilities when participating in telemedicine
  • Discuss the potential benefits, constraints, and risks (e.g.,privacy and security) of telemedicine
  • You may want to outline some of your basic telemedicine program policies around billing, scheduling, cancellation etc
  • Disclose to patients of technology or equipment failures during service sessions and the contingency plans in case of technical failure

Download our free sample Telehealth Consent Form.

We suggest you have legal consult review it, and make adjustments based on your business legal needs. You’ll want to tailor this form to meet your state telehealth requirements, explain your business telehealth policies and speak to the technology you choose to use to conduct your telehealth services.

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