Telehealth & Patient Consent
DRAFT — requires review by qualified legal counsel before publication. Placeholders in [brackets] must be completed.
Telehealth consent
I consent to receive a medical evaluation through telehealth and understand its benefits, risks and limitations.
Patient consent
I confirm the information I provide is accurate and that I will be physically located in the state I selected during my visit.
Clinical determination
I understand the clinician independently determines whether documentation is appropriate.
State-specific terms
[State-specific telehealth consent requirements to be added by counsel.]