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A telehealth consent form records that a patient understands how a virtual visit works, its limits and their rights, and agrees to receive care that way, and HHS's telehealth office says “you may be required to get their official informed consent” because “specific informed consent laws vary by state” (telehealth.hhs.gov). AHRQ publishes a sample form and notes that “Some States do not require documented informed consent for telehealth, but there are still advantages to using the AHRQ Easy-to-Understand Telehealth Consent Form” (AHRQ). Curve Compliance's HIPAA intake forms can host your consent text and checkboxes under the BAA Curve signs on every plan, with form answers never sent to ad platforms.
Book a call. Want a Curve Forms demo, or a review of your telehealth intake funnel? Curve Compliance hosts intake forms, including your consent text and checkboxes, under the BAA it signs on every plan, keeps form answers away from ad platforms and can redirect patients to booking after they submit. Curve's team does the setup, typically live in about a week. Book a call with Curve.
What a telehealth consent form is
It is the written side of the informed consent conversation for virtual care. AHRQ says “Clinicians can use the easy-to-understand language from the form when they are having the consent discussion,” and “Clinicians can use the form as a checklist to make sure they have covered all the information required by informed consent rules” (AHRQ).
It is also different from a HIPAA consent or authorization. A telehealth consent form is about consent to the care itself. HIPAA consent and HIPAA authorization are about how health information is used and shared. Keeping those apart makes each one clearer for the patient, as the section on privacy and marketing consent below explains.
Do you need written consent?
It depends on your state and the care you provide. HHS's telehealth office advises: “When you meet with a patient, explain what they can expect from the telehealth visit and what their rights are,” and “Ensure the informed consent and other compliance documentation has been received and/or is documented during check-in, including verbal consent” (telehealth.hhs.gov). AHRQ says patients “can give their consent verbally at the beginning of their first telehealth visit, and clinicians can document it in the medical record,” and that “a signature can be obtained through your patient portal and the U.S. mail” (AHRQ).
AHRQ is direct about its own sample: “The AHRQ Sample Consent Form must be adapted before using it,” and “Check with your lawyer before using the form. Laws on informed consent vary from State to State” (AHRQ). HHS's telehealth office also says to “Make sure to have your medical/intake forms reviewed by your legal team” (telehealth.hhs.gov). Use the template below as a checklist, and talk to your counsel about the final wording for each state you serve.
Template: the sections to include
Each row names a section, what it covers and where the point comes from. Write the wording in plain language your patients can read, and translate it where needed.
| Section | What it covers | Where it comes from |
|---|---|---|
| 1. Patient and visit details | Patient name, date of birth, the clinician or practice, and the date | Your intake process |
| 2. What telehealth is and what to expect | How the visit works by video or phone, and what the patient can expect | “explain what they can expect from the telehealth visit and what their rights are” (telehealth.hhs.gov) |
| 3. Limits and in-person care | When the clinician may refer the patient to an in-person visit | “What circumstances will require a referral to in-person treatment or care?” (telehealth.hhs.gov) |
| 4. Privacy on the patient's side | Finding a private place, using headphones | “wearing headphones and finding a place to be alone during the visit to ensure privacy on their end” (telehealth.hhs.gov) |
| 5. Who may be present | Anyone observing or joining the visit | “If there's anyone observing the visit, tell the patient and get their consent at the start” (telehealth.hhs.gov) |
| 6. Location and emergency plan | Where the patient is at each visit, a local emergency contact, and what happens if the call drops | “Confirm the patient's exact location at the beginning of each telemedicine appointment” and “What happens if the call is disconnected during an emergency?” (telehealth.hhs.gov) |
| 7. Patient rights | The rights your state and practice give the patient, such as asking questions or choosing in-person care where you offer it | “what their rights are” (telehealth.hhs.gov); your state's rules |
| 8. Agreement and how consent is recorded | A short agreement statement, the date, and how consent is documented | Verbal consent documented in the record, or a signature by patient portal or mail (AHRQ) |
Keep privacy notice acknowledgment and marketing permission out of this form, or ask for them in separate checkboxes, as the next section explains. Pair the form with the questions you ask before the first visit: see telehealth intake form questions and the patient intake form template.
Privacy consent vs marketing consent: keep them separate
Consent to telehealth care, an acknowledgment of your privacy practices and permission to market are three different things. HIPAA says a covered entity “may obtain consent of the individual to use or disclose protected health information to carry out treatment, payment, or health care operations,” but that such consent “shall not be effective to permit a use or disclosure of protected health information when an authorization, under § 164.508, is required” (45 CFR 164.506(b)). Marketing uses of PHI generally need that authorization (45 CFR 164.508(a)(3)).
Bundling all three into one checkbox blurs what the patient agreed to. For the differences, see HIPAA consent form, HIPAA release form and the HIPAA marketing rule.
Hosting the form: where it lives and what it sends
An online consent form is also a web page, and HHS describes a tracking technology as “a script or code on a website or mobile app used to gather information about users or their actions as they interact with a website or mobile app.” HHS's example is a patient who “makes an appointment through the website of a covered health clinic”: if that site uses third-party tracking, “the tracking technology vendor is a business associate, and a BAA is required” (HHS). A consent step that loads ad tags raises the same question.
Host the form with a vendor that signs a BAA, keep ad tags off the consent step, and send ad platforms only a neutral event once the patient books. See where telehealth intake forms leak.
How Curve Compliance helps
Curve Forms hosts intake and consent steps under the BAA Curve signs on every plan. Statement fields hold your consent text, and separate checkboxes record privacy consent and marketing consent. A guided flow can show one step per card with a progress bar, and logic can screen people out by age, service area or insurance before they reach the consent step, each with its own end screen. After submit, a redirect sends the patient to your booking page.
Every submission lands in the Leads inbox with its answers, UTMs and ad click ID, and every view or export of submissions is logged. Read-only and full-access roles control who sees what, and a retention window and legal hold apply to individual leads. Form answers are never sent to ad platforms: Curve sends neutral form events server-side to Meta, Google Ads and your other destinations through your event mappings, and strips PHI before data reaches an ad platform. Curve is SOC 2 Type II, and its team does the setup, typically live in about a week. Moving from another form tool? See Typeform alternatives for healthcare.
Sources, checked November 9, 2026: AHRQ, Easy-to-Understand Telehealth Consent Form; telehealth.hhs.gov Obtaining informed consent and Creating an emergency plan; 45 CFR 164.506 and 45 CFR 164.508 (eCFR, current as of November 5, 2026); HHS, Use of Online Tracking Technologies.
Frequently Asked Questions
What is a telehealth consent form?
It is a form that records a patient's informed consent to receive care by video or phone, after the clinician explains how the visit works, what to expect and the patient's rights (telehealth.hhs.gov). AHRQ offers a sample that must be adapted before use (AHRQ).
Is a telehealth consent form required?
It depends on your state. HHS's telehealth office says “specific informed consent laws vary by state,” and AHRQ notes that “Some States do not require documented informed consent for telehealth” (telehealth.hhs.gov; AHRQ).
Is verbal consent enough for telehealth?
In some states it can be. AHRQ says patients “can give their consent verbally at the beginning of their first telehealth visit, and clinicians can document it in the medical record” (AHRQ), so check what your state requires.
What should a telehealth consent form include?
Patient and visit details, what telehealth is and what to expect, when in-person care is needed, privacy on the patient's side, who may be present, location and an emergency plan, the patient's rights, and how consent is recorded.
Can a telehealth consent form be online?
Yes. AHRQ suggests patients can “virtually sign the consent form in your patient portal, if you have one” (AHRQ). If you host the form on your website, use a form tool that signs a BAA and keep ad tags off that page.
Is a telehealth consent form the same as a HIPAA authorization?
No. A telehealth consent form covers consent to virtual care, while a HIPAA authorization covers specific uses or disclosures of health information, such as marketing (45 CFR 164.508). See HIPAA consent form and HIPAA release form.
Can I use the AHRQ telehealth consent form as is?
No. AHRQ says “The AHRQ Sample Consent Form must be adapted before using it,” and lists steps such as filling in the highlighted areas, adding your logo, checking with your lawyer and translating it (AHRQ).
Talk to Curve Compliance
Book a call. Building a telehealth consent and intake flow? See a Curve Forms demo and get a review of your intake funnel: consent text and separate privacy and marketing checkboxes, hosted under a BAA on every plan, with form answers never sent to ad platforms. Book a call with Curve.