telehealth consent policy and billing text on computer image

Launch your telehealth by using this template that gets you set up for success! This form is customizable in a word format which can printed or copy and pasted into your EHR. 

It is robust template includes the following areas:

  • Telehealth explanation and consent (page 1)
  • Getting Started- process for collecting forms, sending in insurance cards (page 2)
  • Scheduling and office policies– no show, attendance¬†(page 2)
  • Billing terms and consent – including billing insurance (page 3)
  • Dietitian Service and Consent for service (page 4)


Average rating: 1.00 out of 5 stars
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  • not good

    spelling errors make this a document I’m not happy with and feel it’s a wasted 7.99.

    • Hello! Thank you so much for bringing this to my attention. It looks like the wrong one was uploaded. We trying to get this resource out ASAP and lots going on with COVID-19 and uploaded the non-saved version. My apologies.

      This template has been updated to the final version and a copy has been emailed to you directly.

      Thank you again! Stay health,

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