Telemental health consent form template pdf 2026

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The document is a Telemedicine Informed Consent Form in which the patient consents to engage in telemedicine with their psychotherapist. It outlines the nature of telemedicine, the patient's rights regarding consent and confidentiality, potential risks associated with telemedicine, and the understanding that results cannot be guaranteed. The patient acknowledges their right to access medical information and confirms that they have discussed the content with their psychotherapist.

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01. Edit your telehealth form sign online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send telemedicine form sign via email, link, or fax. You can also download it, export it or print it out.

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Click ‘Get Form’ to open the telemental health consent form in the editor.
Begin by entering your name in the designated field at the top of the form. This identifies you as the patient consenting to telemedicine services.
Next, fill in the name of your psychotherapist. This ensures clarity on who will be providing your care through telemedicine.
Review and acknowledge your rights regarding telemedicine outlined in the form. You may want to highlight or annotate these sections for easy reference.
Sign and date the form at the bottom. If someone else is signing on your behalf, indicate their relationship to you in the provided space.
Finally, ensure that both you and your psychotherapist sign where indicated, confirming mutual agreement to proceed with telemedicine services.

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