Telehealth Consent Form

Easily obtain informed consent from your patients before engaging in Telehealth services with our quick and easy-to-fill Telehealth Consent Form. While this sample is drafted in general terms and meant to collect basic patient contact information, with just a few clicks you can complete your form with additional fields and questions to fit your particular practice, and align it with state-specific laws and requirements. You can also set up automatic delivery of form submissions to other platforms you use, like Google Drive, Dropbox, Google Calendar, and much more, taking your telemedicine practice to the next level with MightyForms' free custom Telehealth Forms.

Design & Personalize

Use this free template and customize your Service Request Forms anyway you like. With MightyForms’ drag & drop editor, you can easily add, edit and delete a variety of fields. Include your logo and the colors and theme of your choosing. Any edit you make to the theme of the form is saved to your account, so you can use it on other forms. Add a personalized pop-up or confirmation e-mail to your respondents.

Publish & Integrate

Publish your Service Request Forms with a click of a button. Just copy and paste the code to embed it on a website, send it to an email list or share it over social media. You can integrate your Service Request Forms with Google Tag Manager and Google Analytics, that way you can more easily keep track of how well it is performing. You can also integrate your form with thousands of apps through Zapier.

Collect & Share

Keep track of real-time results and views of your forms right on your MightyForms account. Our templates are 100% responsive, so your respondents can fill out your Service Request Forms from any device. Edit existing entries and download the reports anytime. You can also customize notification emails to be sent to you and members of your team, optimizing your workflow and keeping everyone on the same page.

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