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Telehealth New Patient Consent Form

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Telehealth New Patient Consent Form

New patient consent form

Page 1

Please read the following information carefully before signing the consent form.

Email*

Introduction*

Consent*

I have read and understand the information provided.

I have had the opportunity to ask questions and have had them answered to my satisfaction.

I consent to participate in telehealth services.

Patient Name*

Date of Birth*

Select date

Address*

Description:Fill out and sign the Telehealth New Patient Consent Form online. This form is required for all new patients before their first telehealth appointment.

Welcome to our telehealth practice! We are excited to offer you the convenience of virtual appointments. Before your first appointment, we require all new patients to fill out and sign our Telehealth New Patient Consent Form. This form outlines the terms and conditions of our telehealth services, including privacy policies, payment policies, and technology requirements. By signing this form, you acknowledge that you have read and understood these policies and agree to abide by them. Our goal is to provide you with the best possible care, and we believe that telehealth services can help us achieve that goal. Thank you for choosing our practice, and we look forward to seeing you virtually!

First Name*

Last Name*

Date of Birth*

Select date

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Last Name*

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Last Name*

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