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Telehealth Counseling Consent Form

Collect consent forms and e-signatures with an online Telehealth Counseling Consent Form. Easy to customize and share. Opt for HIPAA compliance.

Telehealth Counseling Consent Form

Please read the following information carefully and sign below to indicate your agreement.

Email*

Consent to Telehealth Counseling*

I understand that telehealth counseling involves the use of electronic communications to enable health care providers to provide counseling services to me from a remote location.

I understand that telehealth counseling may not be as complete as face-to-face counseling.

I understand that I have the right to withhold or withdraw my consent to the use of telehealth counseling at any time without affecting my right to future care or treatment.

I understand that I have the right to inspect all information obtained and recorded in the course of a telehealth counseling interaction and may receive copies of this information for a reasonable fee.

Patient Name*

Date of Birth*

Address*

Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Patient Signature*

10.

Date*

Select date

Description:Collect consent forms and e-signatures with an online Telehealth Counseling Consent Form. Opt for HIPAA compliance.

Telehealth Counseling Consent Form is an online form that allows you to collect consent forms and e-signatures from your clients for telehealth counseling sessions. With this form, you can easily customize and share it with your clients to ensure that they understand the terms and conditions of the telehealth counseling sessions. The form is designed to be HIPAA compliant, ensuring that your clients' personal and medical information is kept confidential and secure. The form is easy to use and can be accessed from any device, making it convenient for both you and your clients. By using this form, you can streamline your telehealth counseling process and ensure that you have all the necessary consent forms and e-signatures in one place.

Full Name*

Date of Birth*

Address*

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