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Teletherapy Informed Consent Form

Get informed consent from patients receiving mental health treatment virtually. Easy to customize and fill out on any device. Sync with 100+ apps. No coding.

Page 1

Please read the following information carefully and sign below to indicate your understanding and agreement.

Email*

Patient Name*

Date*

Therapist Name*

Introduction*

Benefits and Risks*

Limits of Confidentiality*

Consent to Treatment*

I agree to receive teletherapy services.

Consent to Payment*

I understand that I am responsible for payment of teletherapy services.

10.

Consent to Technology*

I understand the risks and benefits of using technology for teletherapy services.

Description:Get informed consent from patients receiving mental health treatment virtually. Easy to customize and fill out on any device. Sync with 100+ apps. No coding.

Teletherapy Informed Consent Form is a customizable template that allows mental health professionals to obtain informed consent from patients receiving virtual mental health treatment. The form is easy to fill out on any device and can be synced with over 100 apps. This template is designed to ensure that patients understand the risks and benefits of teletherapy and to protect mental health professionals from potential legal issues. The form can be customized to include specific information about the therapist, the patient, and the treatment plan. With no coding required, mental health professionals can easily create and distribute this form to their patients.

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Patient Information*

Telehealth Services*

Consent to Telehealth Services*

I have read and understand the information provided above.

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

I voluntarily consent to participate in telehealth services.

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