Sample Telehealth Consent Form

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Informed Consent for Telehealth Consultations Template

This post was originally published by Upper Midwest Telehealth Resource Center and provided to NCTRC for syndication.

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The National Consortium of Telehealth Resource Centers (NCTRC) is an affiliation of the 14 Telehealth Resource Centers (TRCs) — 12 regional TRCs and 2 national TRCs, funded individually through cooperative agreements from the Health Resources & Services Administration, Office for the Advancement of Telehealth. The goal of the NCTRC is to increase the consistency, efficiency, and impact of federally funded telehealth technical assistance services. This was made possible by 14 Telehealth Resource Centers and administered through grant #U6743496 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, Department of Health and Human Services.

The information and tools presented on the NCTRC website should not be considered legal advice. The NCTRC is not guaranteeing that any information provided will result in reimbursement from a payer. All materials are strictly for informational and educational purposes only.

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