formisoft

Telehealth Consent for Minors Form

Asks about minor patient full name, patient date of birth, and parent or guardian full name. Built for obtaining parental consent for pediatric telehealth visits.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Consent agreement
Use this templatePrint it instead

Your practice

Telehealth Consent for Minors Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Obtaining parental consent for pediatric telehealth visits
  • Documenting guardian authorization for virtual behavioral health services for adolescents
  • Meeting state telehealth regulations for treating minor patients remotely
  • Ensuring guardians understand privacy and technology requirements for virtual care

Formisoft for Mental HealthFormisoft for Pediatrics

What's inside

Before you publish: Add your practice-approved consent wording before publishing.

Page 1 · Your information

  1. Minor Patient Full NameText
  2. Patient Date of BirthDate
  3. Parent or Guardian Full NameText
  4. Guardian Phone NumberPhone
  5. Guardian Email AddressEmail

Page 2 · Additional details

  1. Technology and Privacy Risks AcknowledgedLong Text
  2. Limitations of Telehealth AcknowledgedLong Text
  3. Guardian Available During SessionLong Text
  4. Consent for Provider to Treat MinorConsent Agreement
  5. Guardian SignatureE-Signature

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Telehealth Consent for Minors Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Telehealth Consent for Minors Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

Use this template