What is it?
The Telehealth Consent Form is a written document for your patient to sign indicating they agree to your Telehealth policies.
Have your patient sign it before/at your first Telehealth patient appointment.
It covers areas like:
- the risks + benefits of receiving care virtually.
- how Telehealth will be delivered (technical platforms, expectations, limitations).
- your professional scope + where you're licensed to practice.
- voluntary consent to receive Telehealth treatment + care.
- communication + confidentiality policies for Telelealth.
Note: Each state defines “Telehealth” and “Telemedicine” differently. Some states legally require written consent, others don’t. ALL states consider this form to be a best practice.
Who needs it?
All licensed medical professionals offering care to patients via Telehealth in states where you’re licensed—like:
- Physicians (all types), nurse practitioners and physician assistants
- Integrative, Functional, and Lifestyle physicians
- Chiropractic physicians
- Acupuncturists
- Naturopathic doctors
- Therapists, counselors and social workers
- Registered dietitians + licensed nutritionists
- Nurses & Nurse Coaches working independently under their Nursing Practice Act
- Physical therapists, occupational therapists, speech therapists
- Dentists
- All licensed medical practitioners working in patient relationships
Legal Love™ Tip:
- Use this form when diagnosing and treating patients under your scope of practice.
- Use it if you’re working with patients as a licensed functional medical practitioner (even if not diagnosing + treating patients.)
- Use this form if you’re using your medical title like “Dr.” or “RD” and working with patients in states where you’re licensed/registered.
Note: This is NOT the correct form if you’re a “coach” working with “clients” across state lines. Use the DIY Client Agreement for 1-on-1 clients. Use the DIY Terms of Use for group programs or online courses. Use the DIY Client Agreement for Hybrid Programs (for programs with BOTH group calls + 1-on-1 calls included.
Client Love
Why do you need it?
This Informed Consent Form helps you:
- Get clear, written patient consent before providing Telehealth services.
- Communicate your Telehealth policies with professionalism + ease.
- Reduce legal risk.
- Be energetically aligned in your sacral chakra by creating clear boundaries + expectations.
This form reduces risk for both you and your patients—building trust through transparency.
What’s included in the DIY package?
- Telehealth Consent Form Template
- Easy-to-edit doc.
- Fill in the blank format you can use right away.
- Plain English - no confusing legalese.
- Created with care + Legal Love™.
How does it work?
- Receive an email from us with instructions.
- Download your DIY template.
- Fill in the blanks.
- Save your changes (don’t skip this step!)
- Share it with your patients—electronically or in person - and keep a signed copy.
What's the investment?
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