Consent to Use Telehealth for Psychotherapy
None

Here is a copy of the consent form I use with clients who want to use telehealth.  The form is based on California requirements for telehealth, so you may need to edit it for your state.

You can view a PDF copy of the consent form by clicking here.

17 comments

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    Anne Graham, MSFT

    Love it! Thanks Ryan!

     

    Love it! Thanks Ryan!

     

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    Vicci Phillips, LPCC

    Thank you!

    Thank you!

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    Sarah Gallagher

    Thank you! 

    Thank you! 

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    Ryan Buchmann

    Please remember to vote this form up if you like it so Simple Practice will add it to the template library.

    Please remember to vote this form up if you like it so Simple Practice will add it to the template library.

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    Joyce Lampert

    i cant find this to make it a form that someone needs to sign. Please help.

    i cant find this to make it a form that someone needs to sign. Please help.

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    Ryan Buchmann

    You will have to download the form I have made available to your local drive, then create a new template within Simple Practice in your account.  Copy the contents of the downloaded form and paste it into the new form you are creating in your SP account.  Simple Practice does not yet allow forms to be exported and imported from one account to another.

    You will have to download the form I have made available to your local drive, then create a new template within Simple Practice in your account.  Copy the contents of the downloaded form and paste it into the new form you are creating in your SP account.  Simple Practice does not yet allow forms to be exported and imported from one account to another.

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    Frances M. White

    Thank you, ryan!

    Thank you, ryan!

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    Joyce Lampert

    Thank you!

     

    Thank you!

     

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    Faithe Kimsey, MS, LPC, RPT, NCC

    Thank you for sharing this!

    Thank you for sharing this!

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    Kathryn Orfirer

    There is a telehealth form on simple practice but it says to cut and paste. Then there is supposed to be the availability of clicking for consent. Does this actually happen when it is a cut and paste document?

    There is a telehealth form on simple practice but it says to cut and paste. Then there is supposed to be the availability of clicking for consent. Does this actually happen when it is a cut and paste document?

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    Ryan Buchmann

    To make it a click-n-sign consent form as you are requesting, follow these steps:

    1. From within Simple Practice at the calendar screen, click My Account (look for the gear icon) > Settings > Notes and Forms (on the left).
    2. Click the blue button "Create New Template > Create New Template."
    3. On the right, click the drop down menu that says "for Progress Notes" and change it to "For intake forms."
    4. You are now positioned to create a form that can be clicked to sign.  Bear in mind, the text editing in this form designer is pretty limited (no bolding, underscore, or italicizing).
    5. Click the "Add new" button to create a new paragraph.  Click the dropdown that says "Long Answer" and change to "Paragraph Text."  This allows you to create a paragraph that doesn't require client input.  Copy & paste in your consent form here.
    6. Edit the form according to your needs.  Use all CAPS to emphasize certain statements.  You may want to add an e-signature to each paragraph to obtain evidence that the client read/looked at it.
    7. When you're done with the paragraph, click save.
    8. Click "Add New" again to add the e-signature line.  Click the dropdown and change "Long Answer" to "eSignature."  
    9. In the e-signature description field, enter a statement that essentially says something to the effect of "I read this and I understand it."  Click the checkbox "Require e-signature" so the client must click the signature box in order to submit the completed consent form.  Click Save to save the e-signature line.
    10. Return to the top of the form and click the Save button on the right to save the form.  Don't forget to give the form a name and display name.
    11. Your form is done.  It should appear in the list of intake forms (scroll down to see it).  Click the little eyeball icon on the right to preview it.
    Edited by Ryan Buchmann

    To make it a click-n-sign consent form as you are requesting, follow these steps:

    1. From within Simple Practice at the calendar screen, click My Account (look for the gear icon) > Settings > Notes and Forms (on the left).
    2. Click the blue button "Create New Template > Create New Template."
    3. On the right, click the drop down menu that says "for Progress Notes" and change it to "For intake forms."
    4. You are now positioned to create a form that can be clicked to sign.  Bear in mind, the text editing in this form designer is pretty limited (no bolding, underscore, or italicizing).
    5. Click the "Add new" button to create a new paragraph.  Click the dropdown that says "Long Answer" and change to "Paragraph Text."  This allows you to create a paragraph that doesn't require client input.  Copy & paste in your consent form here.
    6. Edit the form according to your needs.  Use all CAPS to emphasize certain statements.  You may want to add an e-signature to each paragraph to obtain evidence that the client read/looked at it.
    7. When you're done with the paragraph, click save.
    8. Click "Add New" again to add the e-signature line.  Click the dropdown and change "Long Answer" to "eSignature."  
    9. In the e-signature description field, enter a statement that essentially says something to the effect of "I read this and I understand it."  Click the checkbox "Require e-signature" so the client must click the signature box in order to submit the completed consent form.  Click Save to save the e-signature line.
    10. Return to the top of the form and click the Save button on the right to save the form.  Don't forget to give the form a name and display name.
    11. Your form is done.  It should appear in the list of intake forms (scroll down to see it).  Click the little eyeball icon on the right to preview it.
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    Jennifer Zwarich

    Thank you so much!

    Thank you so much!

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    Rachel Hunt

    Ryan, Thank you for sharing!  I’m not sure how to “vote this form up” but I would be glad to do that

    Ryan, Thank you for sharing!  I’m not sure how to “vote this form up” but I would be glad to do that

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    Ryan Buchmann

    Simply click the little heart icon at the top of the thread to vote up.

    Simply click the little heart icon at the top of the thread to vote up.

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    Rachel Hunt

    I had done that, perfect 👍🏽

    I had done that, perfect 👍🏽

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    Gail N. Liguore

    I need to know how to send the consent forms to new clients. Videos are toooooo fast

    I need to know how to send the consent forms to new clients. Videos are toooooo fast

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    Ryan Buchmann

    I had to watch the video several times to figure it out.  Yes, they are pretty quick, but after a few views, they make sense.

    I had to watch the video several times to figure it out.  Yes, they are pretty quick, but after a few views, they make sense.