A telehealth consent form should make virtual care clear before treatment starts
A telehealth consent form gives clients plain-language information about receiving behavioral health services by video, phone, or another remote method. For therapists, counselors, social workers, psychologists, psychiatrists, and other behavioral health professionals, the form helps set expectations before the first remote session begins.
The best forms are not long for the sake of being long. They explain how telehealth works, what privacy protections apply, what risks clients should understand, what happens during a technology failure, and how emergencies will be handled if the client is not physically in the same room as the clinician.
This article includes a free telehealth consent form example you can adapt for your practice. It also explains what to include, how to use the form in your intake workflow, how telehealth consent differs from a progress note, and how AI-assisted documentation tools such as AutoNotes can help with session documentation after consent is obtained.
What a telehealth consent form does in a behavioral health practice
Telehealth consent is part of informed consent. It documents that the client has been told how remote services work and has agreed to participate under those conditions. In behavioral health, this matters because therapy often involves sensitive information, emotional risk, safety planning, crisis procedures, and ongoing communication outside the session.
A strong telehealth consent form usually supports four practical goals:
- Client understanding: The client knows what to expect from remote sessions, including limits of technology and confidentiality.
- Clinical clarity: The clinician has confirmed location, emergency contacts, backup communication methods, and crisis procedures.
- Administrative consistency: The practice uses the same consent process across clients instead of rewriting language each time.
- Documentation support: The signed form creates a record that consent was reviewed and accepted before telehealth services were provided.
Requirements can vary by state, license type, payer, setting, and client population. A template can save time, but it should be reviewed against your practice policies and any rules that apply to your work.
Free telehealth consent form template for therapy practices
Use the sample below as a starting point. Replace bracketed language with your practice details. If you work with minors, couples, families, mandated clients, or clients across state lines, add language specific to those services.
Telehealth informed consent sample language
Practice name: [Practice Name]
Clinician name and credentials: [Clinician Name, License Type]
Client name: [Client Name]
Date of birth: [Client Date of Birth]
Date reviewed: [Date]
Purpose of telehealth services: I understand that telehealth allows me to receive behavioral health services from my clinician through video, phone, or another approved remote communication method. These services may include assessment, individual therapy, family therapy, couples therapy, group therapy, medication management, treatment planning, consultation, or other clinically appropriate services offered by the practice.
Voluntary participation: I understand that participation in telehealth is voluntary. I may ask questions about telehealth services at any time. I may request in-person services if they are available through this practice, or I may ask for referrals if telehealth is not clinically appropriate for my needs.
Potential benefits: Telehealth may make it easier to attend sessions when travel, scheduling, health concerns, disability, caregiving responsibilities, or distance make in-person care difficult. I understand that telehealth may not be appropriate for every clinical situation.
Potential risks and limits: I understand that telehealth has possible risks, including technology problems, poor internet connection, interruptions, audio or video failure, and limits to privacy if I am not in a private location. I also understand that my clinician may determine that telehealth is not clinically appropriate and may recommend another level of care or a different service format.
Privacy and confidentiality: My clinician will take reasonable steps to protect my privacy during telehealth sessions. I agree to participate from a private location when possible and to tell my clinician if another person is present or able to hear the session. I understand that confidentiality has legal and ethical limits, including situations involving risk of harm to self or others, abuse or neglect reporting, court orders, or other exceptions required by law.
Technology and communication: I agree to use the telehealth platform, phone number, or communication method provided by the practice. I understand that email, text messaging, voicemail, and portal messages may have limits and should not be used for emergencies unless the practice has specifically instructed otherwise.
Backup plan for technology failure: If the video connection fails, my clinician may attempt to reconnect or contact me by phone at [Client Phone Number]. If we cannot reconnect within [Number] minutes, the session may be rescheduled or completed by phone if clinically appropriate and allowed by practice policy.
Client location during sessions: I agree to provide my physical location at the start of each telehealth session, including the address where I am located. I understand this information may be needed if there is an emergency during the session.
Emergency procedures: I understand that telehealth is not an emergency service. If I am experiencing an immediate safety concern, I should call emergency services, go to the nearest emergency department, or contact a crisis resource available in my area. I agree to provide an emergency contact if requested by the practice.
Recording: I agree not to record telehealth sessions without written permission from my clinician. I understand that my clinician will not record sessions without my knowledge and consent unless required or permitted by applicable policy and law.
Fees, billing, and insurance: I understand that telehealth services may be billed to me or my insurance according to the practice’s financial policies. Coverage for telehealth may depend on my plan, payer rules, service type, diagnosis, location, and other factors.
Consent acknowledgment: I have read and understand this telehealth informed consent form. I have had the opportunity to ask questions. By signing below, I consent to receive behavioral health services through telehealth.
Client signature: ___________________________ Date: __________
Parent/guardian signature, if applicable: ___________________________ Date: __________
Clinician signature: ___________________________ Date: __________
Sections every telehealth consent form should address
A template becomes more useful when each section has a clear purpose. The form should not read like a technical manual. Clients need enough information to make an informed decision without being buried in vague policy language.
Client identity, location, and contact information
Telehealth creates a basic clinical challenge: the clinician and client are not in the same physical space. Your form should explain that the client may be asked to confirm their current location at the start of each session. Many clinicians document this in the progress note as well.
Include fields or workflow prompts for:
- Client name, date of birth, and preferred contact number.
- Physical location during the session, especially for remote or traveling clients.
- Emergency contact name and phone number, when clinically appropriate.
- Backup contact method if the video platform fails.
This section is especially useful for clients who attend sessions from different places, such as a college dorm, workplace, parked car, shared housing, or a family member’s home.
Nature of telehealth services
Clients should understand what services may be provided remotely. For example, a solo therapist may offer individual psychotherapy and intake assessments by video, while a psychiatric provider may offer medication management visits. A group practice may offer individual therapy, group therapy, family sessions, and treatment planning.
Use language that reflects your actual scope of services. Avoid listing services you do not provide. If certain services require in-person care, say so in the form or in your intake materials.
Privacy, confidentiality, and limits
Telehealth consent should explain that confidentiality still applies, while also naming the practical privacy risks of remote care. A client joining from a kitchen table, rideshare vehicle, or workplace break room may not have the same privacy as a therapy office.
Your language can ask clients to use headphones, choose a private location when possible, avoid recording, and tell the clinician if someone else is present. It should also refer to the usual limits of confidentiality, including safety concerns and reporting obligations.
Technology risks and backup plans
Video sessions can freeze. Audio can fail. A client may lose connection during a difficult moment. The consent form should tell clients what will happen next.
For example, your policy might state that the clinician will try to reconnect once, then call the client by phone. If contact cannot be restored within a set time, the appointment may be rescheduled or documented according to the practice’s missed session policy.
Consent is separate from the telehealth progress note
Telehealth consent and the progress note serve different purposes. The consent form documents agreement to receive services remotely. The progress note documents what happened during a specific clinical encounter.
For a telehealth therapy session, the progress note often includes the service type, date, duration, modality, client location, interventions used, client response, progress toward treatment goals, risk observations when relevant, and plan for next session. The consent form does not replace that note.
Common progress note formats for telehealth sessions
Therapists often use the same note formats for telehealth that they use for in-person care. The format should fit the service and the documentation standards of the practice.
- SOAP notes: Organize the note into Subjective, Objective, Assessment, and Plan sections.
- DAP notes: Focus on Data, Assessment, and Plan, often with a concise therapy-friendly structure.
- BIRP notes: Document Behavior, Intervention, Response, and Plan.
- GIRP notes: Connect the session to Goals, Intervention, Response, and Plan.
For example, a DAP note for a telehealth session might document that the client attended by secure video from home, discussed panic symptoms related to work stress, practiced paced breathing and cognitive reframing, responded with reduced distress by the end of session, and agreed to track panic triggers before the next appointment.
How AI-assisted notes fit after consent is completed
AI-assisted documentation tools can help clinicians create structured, editable drafts from session details. They do not replace informed consent, clinical judgment, or the clinician’s responsibility to review the final note.
In a telehealth workflow, a therapist might confirm consent during intake, provide services by video, then use an AI note tool to draft a SOAP, DAP, BIRP, or other note format. The clinician still reviews the draft, edits clinical language, confirms accuracy, and finalizes the record.
How to use the template in your intake workflow
A telehealth consent form works best when it is part of a repeatable intake process. If clients receive the form at the last minute, they may sign without understanding it or delay the first session because they have questions.
A practical workflow can look like this:
- Send the form before the first telehealth appointment. Include it with your intake packet, practice policies, privacy notice, and financial agreement.
- Ask the client to review it before session. Give them time to ask questions rather than treating consent as a checkbox.
- Confirm consent during the first session. Briefly review key points such as privacy, emergencies, technology failure, and client location.
- Store the signed form with the clinical record. Keep it in the same system or record location your practice uses for consent documents.
Some practices also add a short reminder in the first telehealth progress note, such as: “Telehealth consent reviewed and signed prior to session. Client confirmed current location and emergency contact information.” Use wording that matches your policies and documentation requirements.
Common mistakes that weaken telehealth consent
Many consent problems come from unclear language rather than missing pages. A client should be able to read the form and understand what will happen if the video fails, what privacy limits exist, and what to do during a crisis.
Using vague technology language
“Services may be provided electronically” is usually too broad to be useful. Name the type of service more clearly: secure video, phone, client portal, approved messaging system, or another practice-approved method. If your platform changes, update the form.
Forgetting the emergency plan
Telehealth consent should address what happens if a client is at risk and not physically present with the clinician. At minimum, many practices collect the client’s current location, emergency contact, and local emergency resources when relevant.
Not discussing privacy on the client’s side
The clinician may use a private office and secure systems, but the client’s environment still matters. A client attending from a shared bedroom, parked car, or workplace may need help thinking through privacy options.
Letting the form become outdated
Review the form whenever your telehealth platform, services, billing practices, state rules, payer requirements, or emergency procedures change. Many practices also schedule an annual policy review.
Special situations that may need added consent language
A general template may not be enough for every client or service. Certain settings require more detail because the clinical, legal, or practical issues are different.
Consider adding tailored language for:
- Minors: Parent or guardian consent, adolescent privacy, custody documentation, and who may participate in sessions.
- Couples and families: No-secrets policies, multiple participants, location of each participant, and recording expectations.
- Group therapy: Participant privacy, expectations for joining from a private space, and limits of confidentiality among group members.
- Medication services: Prescribing policies, pharmacy information, lab work, vitals, and situations requiring in-person evaluation.
If you provide services to clients located in more than one state, review licensure and telehealth practice rules before offering care. Do not rely on a generic form to resolve cross-jurisdiction questions.
How AutoNotes supports telehealth documentation after consent
AutoNotes is built for behavioral health documentation, including telehealth sessions. After the client has completed the appropriate consent process, AutoNotes can help turn session details into structured, editable progress note drafts.
For a therapist seeing telehealth clients throughout the day, the documentation burden often shows up after hours. The clinician may still need to write interventions, client response, progress toward treatment goals, risk notes, and the plan for next session. AutoNotes gives clinicians a faster starting point while keeping them in control of the final record.
Clinicians can use AutoNotes for common behavioral health workflows, including individual therapy, group therapy, intake sessions, assessments, and treatment planning. Drafts can be shaped around note formats such as SOAP, DAP, BIRP, or other service-specific structures.
AutoNotes does not replace the consent process, legal review, or clinical decision-making. It helps with the documentation that follows the clinical service. The clinician reviews, edits, and finalizes each note before it becomes part of the record.
If telehealth notes are taking over your evenings, you can start your free trial and test AutoNotes with your own documentation workflow.
Telehealth consent form checklist
Before using your form with clients, review it for practical completeness. The goal is not to add unnecessary language. The goal is to make sure the client understands the service and the clinician has the information needed to provide remote care responsibly.
- Does the form identify the clinician, practice, client, and date of consent?
- Does it explain what telehealth services may include?
- Does it describe privacy expectations and limits of confidentiality?
- Does it include technology risks and a backup communication plan?
After those core items, check the clinical and administrative details.
- Does it ask for client location and emergency contact information when needed?
- Does it address recording, fees, billing, and insurance limitations?
- Does it include signature lines for the client, guardian, and clinician as applicable?
- Has the form been reviewed against your current policies and applicable requirements?
Frequently asked questions about telehealth consent forms
Do therapists need a separate telehealth consent form?
Many practices use a separate telehealth consent form or a clearly labeled telehealth section within their informed consent paperwork. The best approach depends on your practice policies, state rules, payer expectations, and service model.
What should be included in a telehealth consent form?
Include the nature of telehealth services, potential benefits and risks, privacy expectations, confidentiality limits, technology failure procedures, emergency planning, client location expectations, fees, recording rules, and a consent acknowledgment.
Can I use this telehealth consent form template as-is?
You can use it as a starting point, but you should customize it for your practice. Add your actual platform, services, billing policies, emergency procedures, and any requirements tied to your license, setting, or client population.
How often should a telehealth consent form be updated?
Review it when your practice changes platforms, policies, services, emergency procedures, or billing processes. Many practices also review consent forms at least once a year as part of a documentation policy review.
Can clients sign telehealth consent electronically?
Many practices use electronic signatures for intake and consent forms. Confirm that your electronic signature process fits applicable laws, payer requirements, and your recordkeeping policies.
Should telehealth consent be mentioned in the progress note?
Some clinicians document that telehealth consent was reviewed or already on file, especially during the first telehealth session. The progress note should still focus on the clinical service provided during that encounter.
What if a client refuses to sign the telehealth consent form?
If a client does not consent to telehealth, the clinician should not proceed with remote services unless another valid consent process applies. Depending on the situation, you may discuss in-person options, referrals, or other clinically appropriate next steps.
Does telehealth consent guarantee privacy?
No form can guarantee privacy. The form should explain the steps the practice takes to protect information and the steps clients can take on their side, such as joining from a private location and not recording sessions.
Is telehealth consent required for phone sessions?
Phone sessions may still be considered telehealth depending on the service, payer, and jurisdiction. If your practice provides therapy or behavioral health services by phone, address phone-based care in your consent language.
How does AutoNotes help with telehealth sessions?
AutoNotes helps clinicians create structured, editable progress note drafts after telehealth sessions. It can support documentation for interventions, client response, treatment plan progress, and next steps while leaving final review to the clinician.
Put your consent and documentation workflow in writing
A useful telehealth consent form is clear, specific, and easy to apply in real sessions. It tells clients what remote care involves, explains privacy and technology limits, and gives the clinician a consistent process for emergencies, location confirmation, and backup communication.
Once consent is handled, documentation still needs attention. Telehealth sessions should be recorded in clear progress notes that reflect the service provided, the client’s response, and the plan for ongoing care. AutoNotes can help reduce the time spent drafting those notes while keeping clinical review in the provider’s hands.
Try it free to see how AutoNotes can support your telehealth documentation workflow.
