Telehealth Consent Form

MNT Business Tools

Use this customizable template to create a Telehealth Consent Form for your practice.

  • Release Date: June 2, 2021
  • SKU NSC111-I
Member Price
Nonmember Price

Many states and payers require health care providers to obtain consent from their patients to receive services via telehealth. This customizable form describes telehealth services, the benefits and risks, addresses patient's rights related to telehealth services and includes a space for acknowledgement by the patient or an authorized representative.


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  • Release Date: June 2, 2021
  • SKU NSC111-I