Telehealth consent forms are not just paperwork. They are a legal and ethical requirement that protects both you and your clients. Here is exactly what needs to be in yours, how state laws affect your requirements, and when you need to update consent.
When telehealth exploded during COVID, many therapists threw together consent forms in a hurry. Some borrowed language from colleagues. Others grabbed templates from the internet. A few skipped it entirely, figuring their general informed consent "covered it."
It did not.
Telehealth brings unique risks that your standard informed consent does not address. Technology failures, privacy limitations, emergency protocols across state lines. Your clients need to understand these risks before treatment begins. And you need documentation proving they understood.
Why Telehealth Requires Separate Consent
Your standard informed consent covers the basics of therapy: confidentiality limits, cancellation policies, fees, the therapeutic process. But telehealth introduces considerations that do not exist in face-to-face treatment.
Think about it. Your client's privacy depends partly on their own technology setup. Sessions can be interrupted by internet outages, power failures, or software glitches. You cannot physically intervene in a crisis. Where your client sits during a session might be in a different state or country than where you are licensed. Data travels through servers, networks, and platforms you do not control.
These are not minor technicalities. They fundamentally change the therapeutic environment and what clients should expect from treatment.
The 12 Required Elements of Telehealth Consent
While requirements vary by state, most licensing boards expect telehealth consent forms to address these core elements. Missing even one could expose you to liability or disciplinary action.
Required Elements
- 1 Nature of telehealth services
- 2 Technology requirements and platforms used
- 3 Potential risks and limitations
- 4 Privacy and confidentiality protocols
- 5 Emergency procedures and local resources
- 6 Technical failure backup plans
Also Required in Most States
- 7 Right to refuse or withdraw consent
- 8 Fees specific to telehealth sessions
- 9 Recording policies
- 10 State licensure and location requirements
- 11 Insurance coverage limitations
- 12 Client physical location verification
Detailed Breakdown of Each Element
1. Nature of Telehealth Services
Your consent form needs to explain what telehealth actually is in plain language. Many clients still do not fully understand that telehealth involves real-time interactive communication, not just messaging or emails. Clarify that sessions happen via secure video or audio connection, that you will be in a private location, and that the therapeutic relationship is the same as in-person treatment.
2. Technology Requirements
Clients need to know what technology they will use and what is required on their end. Specify the platform name, whether they need to download software, minimum internet speed recommendations, and device requirements. If your platform works better on certain browsers, say so. Clients should not discover technical issues five minutes into their first session.
Pro Tip: Technology Verification
Schedule a brief technology check before the first session. This ensures clients can connect successfully and gives you documentation that technology was tested and working. Many practices now make this a standard part of onboarding.
3. Potential Risks and Limitations
This is where many consent forms fall short. You must clearly explain that telehealth has limitations compared to in-person care. These include:
- Technology may fail during critical moments
- Nonverbal cues may be harder to read on video
- Certain assessments cannot be conducted remotely
- Crisis intervention is limited by physical distance
- Third parties may overhear if clients are not in private spaces
4. Privacy and Confidentiality
Explain that while your platform is HIPAA-compliant, complete privacy cannot be guaranteed. Technology creates additional privacy risks. Clients should use private, secure internet connections. They should not use public WiFi. They should ensure no one else can hear their session. Your consent should also address whether sessions pass through any third-party servers and what data those platforms collect.
5. Emergency Procedures
This is critical and often overlooked. You need to collect and document:
Emergency Preparation Checklist
- Client physical address at time of each session
- Local emergency contact person
- Local crisis resources in client area
- Nearest emergency room to client location
- Backup phone number if video fails during crisis
- Documented plan for what happens if you cannot reach them
6. Technical Failure Backup Plans
What happens when the video freezes mid-session? Your consent form should outline the exact protocol. Most practices specify: if disconnected, the client should attempt to reconnect within 5 minutes. If that fails, the therapist will call the backup phone number. If that fails, the session will be rescheduled. Clear expectations prevent confusion and anxiety during technical difficulties.
7. Right to Refuse or Withdraw
Clients must understand that telehealth is voluntary. They can request in-person sessions at any time if available, or they can refuse telehealth altogether without it affecting their care. You cannot require telehealth if a client is not comfortable with it, and you should document that this was explained.
8. Fees and Billing
If your telehealth fees differ from in-person fees, disclose this clearly. Also address insurance coverage, as some plans reimburse telehealth differently. Clients should not be surprised by billing issues after treatment has begun.
9. Recording Policies
Be explicit about recording. Most consent forms should state that neither party will record sessions without written permission from the other. Some states require all-party consent for recording. Your policy should reflect your state law and professional standards.
Recording Laws Vary by State
Some states are "one-party consent" states where only one person needs to agree to recording. Others require "all-party consent." If your client is in a different state than you, the stricter standard typically applies. When in doubt, require written consent from all parties before any recording.
10. Licensure and Location Requirements
This is where many therapists get into trouble. You can only provide services where you are licensed. If your client travels to another state, you may not be able to conduct that session legally. Your consent should explain that clients must inform you of their physical location at the start of each session, and that services cannot be provided if they are in a jurisdiction where you are not licensed.
11. Insurance Coverage Limitations
Many insurance plans have specific telehealth policies. Some cover telehealth at parity with in-person sessions. Others have restrictions on which conditions can be treated via telehealth, or require different authorization. Make clients aware that insurance coverage is their responsibility to verify, and that coverage may differ from in-person visits.
12. Physical Location Verification
This is increasingly required by licensing boards. You need to verify and document where your client is physically located at each session. This is not about being intrusive but about ensuring you are practicing legally and can respond appropriately to emergencies. Many practices now make this a standard opening question for every telehealth session.
State-Specific Requirements
Telehealth consent requirements vary significantly by state. Here is a breakdown of what different states require:
Stricter States
States like California, Texas, and New York have detailed telehealth consent requirements including:
- - Specific language that must appear verbatim
- - Required disclosures about supervision
- - Documentation of verbal consent discussions
- - Annual renewal requirements
More Flexible States
Other states provide general guidance without specific language requirements:
- - Must obtain informed consent for telehealth
- - Must document consent was obtained
- - Format left to provider discretion
- - Updates required when circumstances change
Check Your State Board
State requirements change frequently. Check your licensing board website at least annually for updates to telehealth consent requirements. Many boards updated their requirements in 2023 and 2024 as pandemic flexibilities expired and permanent telehealth regulations took effect.
When to Update or Renew Consent
Consent is not one-and-done. You should update or renew telehealth consent when:
- You change telehealth platforms or technology
- Your fees change
- State regulations are updated
- The client moves to a new location
- You add new services or modalities
- Annually, as a best practice
Many malpractice insurance carriers recommend annual consent renewal as a risk management strategy. Even if your state does not require it, regular review ensures your consent form reflects current practices and regulations.
Complete Telehealth Consent Form Checklist
Use this checklist to audit your current telehealth consent form or build a new one:
Telehealth Consent Form Audit Checklist
Core Elements
- Definition of telehealth in plain language
- Specific platform and technology described
- Risks and limitations clearly explained
- Privacy and confidentiality protocols
- Complete emergency procedures
- Technical failure backup plan
Additional Requirements
- Right to refuse or withdraw consent
- Fee and billing information
- Recording policy
- Licensure and location requirements
- Insurance coverage disclaimers
- Location verification process
Documentation
- Date of consent clearly documented
- Signature or electronic acknowledgment
- Version number for tracking updates
- Copy provided to client
TheraFocus Makes Compliance Easier
Managing telehealth documentation does not have to be complicated. TheraFocus includes built-in telehealth consent templates, automatic session location tracking, and integrated HIPAA-compliant video built into our platform.
Stop cobbling together separate tools. Start with a practice management platform designed for telehealth from the ground up.
Explore TheraFocus Telehealth FeaturesFrequently Asked Questions
Can I use my regular informed consent for telehealth?
No. Your general informed consent does not address the unique risks and considerations of telehealth. You need a separate telehealth-specific consent form, or a comprehensive addendum to your existing consent that covers all required elements.
Do I need written consent or is verbal consent acceptable?
Most states require documented consent, which means written or electronic signature. Some states allow documented verbal consent, meaning you explain everything verbally and document in your notes that consent was obtained. Check your specific state requirements, but written consent provides the strongest protection.
What if my client is a minor?
For minors, you typically need consent from a parent or legal guardian. Some states have specific provisions for mature minors or emancipated youth. Your consent form should specify who is providing consent and their relationship to the client. Additional considerations apply for minors around privacy within the home during telehealth sessions.
How often should I renew telehealth consent?
Best practice is annual renewal. Some states require specific renewal periods. At minimum, you should obtain new consent whenever there are significant changes to your technology, fees, or state regulations. Many practices include consent renewal as part of an annual paperwork update.
What if my client travels to another state during treatment?
You can only provide services in states where you are licensed. If your client temporarily travels to another state, you may not be able to conduct sessions during that time. Your consent form should address this and explain that clients must notify you of location changes. Some therapists obtain licensure in multiple states to address this issue.
Can clients sign consent forms electronically?
Yes. Electronic signatures are legally valid under federal law (ESIGN Act) and most state laws. Use a HIPAA-compliant electronic signature platform. The key is ensuring the signature is attributable to the signer and that you maintain records of the signed document. Many practice management systems include built-in electronic signature capabilities.
Key Takeaways
- 1 Telehealth requires separate consent from your general informed consent because it introduces unique risks around technology, privacy, and emergency response.
- 2 Cover all 12 required elements including technology requirements, emergency procedures, recording policies, and licensure limitations.
- 3 Verify client location at every session to ensure you are practicing legally and can respond appropriately to emergencies.
- 4 Review and update consent annually or whenever technology, fees, or regulations change.
- 5 Check your state licensing board for specific requirements, as telehealth regulations vary significantly and continue to evolve.
Creating a comprehensive telehealth consent form is not about checking a compliance box. It is about ensuring your clients truly understand what telehealth involves, protecting yourself from liability, and building a foundation of transparency that supports the therapeutic relationship.
Take the time to get this right. Your consent form is often one of the first documents clients see from your practice. A thorough, well-organized consent form signals that you take your professional responsibilities seriously and that you have thought carefully about providing quality care in a telehealth environment.
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TheraFocus Team
Telehealth Specialists
The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.