Telehealth Consent Form Template for Occupational Therapy


Originally published – March 2021. Republished for relevance May 2024.

With 2020 being the year that it was, telehealth and teletherapy became more widely used for so many patients and practitioners. Last year, I wrote a blog post about the three myths surrounding teletherapy and another on having a successful telehealth session with your clients.

Even with the hope of things returning to some sort of “normal”, it looks like providing services virtually to make care more accessible is here to stay! This is part three in our series of different templates aimed at helping you run your clinic better, we’ve talked about invoicing and intake templates and now I’ll show you what you could have in your telehealth consent form template and an example of a template I use myself.

Here are some things you should include in your Telehealth consent form template:

  1. Understanding the risks and limitations: You must inform your patient about the limitations of telehealth compared to in-person sessions and address the specific differences in practices and risk associated with in-house care through telehealth.
  2. Safety protocols: This information should include a personal emergency contact, and information of local first responders as well as a home address (or location where therapy is being accepted by the patient). These safety protocols would guide the telehealth practitioner and the patient in an emergency such as a heart event or an adverse event like a fall.
  3. Data storage and security policies: If you are recording a session for any reason (such as reviewing the session for analysis) you need to inform your client and offer them the option to refuse. You also need to make sure any electronic personal identifiable information (ePII) is stored in a safe and secure place that meets Canadian privacy laws.
  4. Confidentiality: In your telehealth consent form template, confidentiality is very important and is the foundation of the practitioner-patient trust relationship! 
  5. Right to withdraw consent: It should always be written into your telehealth consent form template that patients are able to withdraw this consent at any time, without affecting my right to future care.


When starting Telehealth with a client…

It is important to be clear and transparent about what they can expect and the process from how to access the session to what the session will include. Here are a few other things for consideration when thinking about your Telehealth consent form template and a few myths to bust. 

  • Session Length – sessions are typically 30 to 60 minutes depending on the focus area and the attention span of the client
  • Send a note ahead of the session (this could be the plan from your last session), with a list of the materials they may need for the session.
  • Plan to spend 5 minutes of your first session to get set up, have your client collect materials required for the session. 
  • Keep it simple, do similar activities that you would do if you were in the same room together. It doesn’t have to be table top or even computer related activities.
  • To learn more about Telehealth sessions, check out this mock telehealth session using Therabyte we put on youtube. 


Here’s the telehealth consent form template for you.

Disclaimer: This information is freely shared but not to be taken as legal advice. 


Since using Therabyte, I have been able to take this telehealth consent form template and include it in my consent process streamlining and secure through the platform. Allowing me an improved workflow through automation and centralized documents! Ready to learn how I use Therabyte EMR to improve my client intake process?




As you can probably tell, I’m a huge advocate of automation and while this telehealth consent form template can help you get started, when you’re ready to jump to the next level, Therabyte EMR can help!


Looking forward to connecting soon, please reach out with any comments or questions at


Ashley Reina,

Occupational Therapist & Co-founder of Therabyte App


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