Sample Telehealth Informed Consent Form

Telehealth in the United States is currently affected by laws and regulations at the federal and state levels. Currently, there is no uniform legal approach to telehealth nutrition. Telehealth laws and regulations are still determined by each state government, which continues to be a major challenge in its provision. A “Telehealth Informed Consent Form” explains the virtual services that you provide, as well as the risks and benefits associated with care provided via telehealth. Essentially, it ensures that the patient understands how care will be provided virtually, and any perceivable limitations associated with a virtual (versus in-person) session.

Depending on your state, receiving a telehealth informed consent form may be required for your profession (regulations vary by profession, depending on state regulations). In states without strict regulation for dietitians, nutritionists or other wellness professionals, clients may legally only need to provide their verbal consent for telehealth care.

While getting a patient’s consent for telehealth visits may not be a requirement in your state, you may still want to consider having your client’s fill out a telehealth informed consent form regardless of the regulations. It’s also best practice to document in every session note that your client verbally agreed to conduct the session using telehealth.

The American Telemedicine Association published practice guidelines for telehealth care. Within this guide, there are several suggestions on what to provide within a Telehealth consent form, including:

  • Inform patients of their rights when receiving telemedicine, including the right to suspend or refuse treatment
  • Inform patients of their own responsibilities when participating in telemedicine
  • Discuss the potential benefits, constraints, and risks (e.g.,privacy and security) of telemedicine
  • You may want to outline some of your basic telemedicine program policies around billing, scheduling, cancellation etc
  • Disclose to patients of technology or equipment failures during service sessions and the contingency plans in case of technical failure

Download our sample Telehealth Consent form below, but be sure to have legal consult review it, and make adjustments based on your business legal needs. You’ll want to tailor this form to meet your state telehealth requirements, explain your business telehealth policies and speak to the technology you choose to use to conduct your telehealth services.

Interested in learning more about Healthie’s telehealth platform? Read more here: “Telehealth: Incorporating Virtual Services into Your Nutrition Business.”

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