Sample Telehealth Consent Forms

In our prior Blog entry: “Your Changing Practice – Telehealth During the Coronavirus (COVID-19) Crisis,” we noted many considerations and resources to assist you during this time.  Many of you, or your organizations, have not previously engaged in telehealth.  We created two sample consent forms to be used for patients.  They each have a different style and, one or the other, may work for your specific practice.  These sample forms are only one element of meeting the standard of care. 

These forms are designed to be an adjunct to your normal informed consent document and do not cover many topics that need to be addressed in order to provide full informed consent to your patients.  They may need to be adapted to address each patient’s specific situation, including addressing emergency and crisis situations that may arise.  It is important to ensure that your informed consent document complies with any applicable ethical requirements, including obtaining informed consent from your patients before engaging in services.  This is a critical ethical consideration and a good risk management strategy.

These sample forms are drafted in general terms and will need to be modified to fit your specific practice.  In addition, it is important for you to know the laws or regulations in your state that govern the practice of telehealth, as these forms do not strive to comply with any specific state laws.  There may be additional elements required for this informed consent to fully comply with your state’s requirements.  You are encouraged to have an attorney review your informed consent for telehealth document prior to using it to ensure it is in compliance with your state laws and regulations.

These documents can be customized according to your specific needs.  Feel free to adapt for your practice or agency.

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation.  At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. 



Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.


Documents to download