Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
Telehealth Consent Form
Telemedicine Consent Form Please provide your consent to receive care via telemedicine.
What is Telemedicine? Telemedicine involves the use of electronic communications to enable healthcare providers to deliver care when the patient and provider are not in the same location.
I understand the benefits and risks of telemedicine, and I agree to participate in telemedicine services.
Full Name *
Date of Birth *
____ / ____ / ________
Today's Date *
____ / ____ / ________
Signature
Date
Telehealth Consent Form template from formisoft.com. formisoft.com/intake-templates/telehealth-consent