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Telehealth Informed Consent

Federal & State Law Editorial TeamLast reviewed: April 2026

Consent form for receiving healthcare services via telemedicine, addressing technology requirements, privacy risks, and limitations of remote care.

PDF TemplateUse the instructions below to complete this form

Instructions

Explain the nature of telehealth services and how they differ from in-person visits. Describe privacy and security measures for the technology platform. Disclose that technical failures may require rescheduling. Inform the patient of their right to refuse telehealth and request in-person care. Address interstate licensing requirements if provider and patient are in different states. State laws on telehealth consent requirements vary.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.