Disclaimer
BuiltSIGN templates are provided for convenience, are not legal advice, and should be reviewed by a licensed attorney in the relevant state.
Healthcare and consent
Telehealth Consent
Consent to care by video or phone, including privacy and emergency limits.
The legal text of this template is still in English. It needs a human translation by someone qualified in that language and jurisdiction. BuiltSIGN does not machine-translate template bodies.
Preview
Needs legal review
Telehealth licensure and consent rules vary by state and by the patient's location during the visit.
Telehealth
The patient consents to care by {{modality}}. The patient understands the visit can be interrupted by technology, that the provider may decide telehealth is not appropriate, and that the patient should call emergency services for an emergency rather than wait for a video visit. T…
Governing law and venue
This agreement is governed by the laws of {{governingLawState}}, without applying conflict-of-law rules that would select another state's law. Venue lies in the state or federal courts located in that state unless a statute that applies to this agreement requires a different foru…
Questions
What is the Telehealth Consent template?
Consent to care by video or phone, including privacy and emergency limits. It is a Healthcare and consent template in the BuiltSIGN gallery.
Who signs this template?
The template includes fields for Provider, Patient.
Is this legal advice?
BuiltSIGN templates are provided for convenience, are not legal advice, and should be reviewed by a licensed attorney in the relevant state.
Is the template text translated?
No. The legal text stays in English until a person qualified in that language and jurisdiction translates it. BuiltSIGN does not machine-translate template bodies.
BuiltSIGN templates are provided for convenience, are not legal advice, and should be reviewed by a licensed attorney in the relevant state.