- Form
Sample Telehealth Consent Form
Our sample telehealth consent form was designed with Arizona and Utah state law in mind and can be downloaded for use at your medical practice.
Our sample telehealth consent form was designed to ensure that patients fully understand and give their consent before engaging in telehealth services. Using this a form like this is crucial in establishing a clear understanding between healthcare providers and patients, as it outlines the terms and conditions of telehealth consultations.
This Telehealth Consent Form template has been prepared by MICA with Arizona and Utah state law in mind.
This sample form is for general informational purposes to help you create a customized form that fits your practice. This sample should not be considered as legal advice. Please consult with an attorney to ensure compliance with state laws, rules, and regulations surrounding telehealth informed consent. You can download and customize this form. Be sure to complete the highlighted fields with your practice-specific information.