Telehealth Consent Form Template | Jotform

Telehealth Forms

105 Templates

Telehealth forms help healthcare practices schedule virtual appointments with patients and collect medical records, informed consent, fee payments, and other important health data online. Whether you’re part of a doctor’s office, teletherapy practice, or dermatology center, you can use Jotform’s free telemedicine forms to securely gather important patient information and diagnose conditions through your website. Simply choose a readymade form template from the list below, customize it to match your practice by adding your logo and updating form fields, then embed it in your website or share it via email to start collecting info online.

To keep sensitive health data protected, be sure to sign up for HIPAA compliance by signing a Business Associate Agreement (BAA) — or if you’re switching to telehealth because of the COVID-19 pandemic, apply for a free unlimited HIPAA account through our Coronavirus Responder Program. You can even automatically send form submissions to other platforms you’re already using, like Google Calendar, Dropbox, Google Drive, and more. Jotform offers an all-in-one solution to collect important info from your patients online — so take your telemedicine practice to the next level with our free Telehealth Forms.

Telemedicine E-Visit Request Form

Telemedicine E-Visit Request Form

Accept requests for e-visits through this free online appointment form. Easy to customize. embed, and share. Integrate with 100+ apps. HIPAA compliance option.

Healthcare Forms

Telemedicine Patient Evaluation Form

Telemedicine Patient Evaluation Form

Evaluate your patients remotely with an online Telemedicine Patient Evaluation Form. Easy to share and collect data on any device. Opt for HIPAA compliance.

Healthcare Forms

Telemedicine Appointment Form

Telemedicine Appointment Form

Let patients request virtual appointments online. Add a calendar field without coding. HIPAA compliance option. Perfect for telemedicine providers.

Healthcare Forms

New Patient Enrollment Form

New Patient Enrollment Form

New Patient Enrollment Form which personal information, contact information, emergency contact people area and medical history information are provided; allowing you to have an easier and faster registration process.

Healthcare Forms

Coronavirus Screening Form

Coronavirus Screening Form

Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA compliance option.

Healthcare Forms

Telehealth Consent Form

Telehealth Consent Form

Get informed consent from patients online. Collect legally binding electronic signatures. Easy to customize for your practice. HIPAA compliance option.

Healthcare Forms

Telemedicine Consent Form

Telemedicine Consent Form

Get consenting e-signatures online from your patients. Add terms and conditions without coding. Free HIPAA compliance option for coronavirus responders.

Healthcare Forms

Mental Health Intake Form

Mental Health Intake Form

Perform patient intake online. Collect medical history, supporting documents, and fee payments. Protect patient data with optional HIPAA compliance.

Healthcare Forms

HIPAA Medical History Form

HIPAA Medical History Form

HIPAA Medical History Form allows gathering patient's contact details with their current symptoms, medications, allergies, drug use, and family medical history that allows for a better healthcare service and management process.

Healthcare Forms

Teletherapy Consent Form

Teletherapy Consent Form

Collect informed patient consent and e-signatures online with a free Teletherapy Consent Form. Great for remote medical services. Get HIPAA compliance today.

Healthcare Forms

Nutrition Consultation Form

Nutrition Consultation Form

A nutrition consultation form is used by medical practices to record details about consultations with patients and their ongoing nutritional needs.

Telehealth Forms

Virtual Care Appointment Form

Virtual Care Appointment Form

Easy appointment scheduling for e-visits. Great for telemedicine! HIPAA compliance option. Embed anywhere. Integrate with 100+ apps. No coding required.

Healthcare Forms

Reiki Intake Form

Reiki Intake Form

Collect client contact info and e-signatures online with a free Reiki Intake Form. Easy to customize, embed, and fill out on any device. Sync with 100+ apps.

Healthcare Forms

Physician Referral Form

Physician Referral Form

Refer patients to other physicians and collect referrals online. Easy to customize and embed. Integrate with 100+ apps. HIPAA compliance option. No coding.

Healthcare Forms

Telehealth Counseling Consent Form

Telehealth Counseling Consent Form

Collect consent forms and e-signatures with an online Telehealth Counseling Consent Form. Easy to customize and share. Opt for HIPAA compliance.

Healthcare Forms

Lifemark Informed Consent Telehealth Treatment

Lifemark Informed Consent Telehealth Treatment

Collect signed patient consent forms online with our free Mental Telehealth Informed Consent Form. Easy to customize and embed. Opt for HIPAA compliance.

Healthcare Forms

Telehealth Physical Therapy Consent Form

Telehealth Physical Therapy Consent Form

Offering virtual physical therapy appointments? Collect signatures and payments from patients online. Easy to customize and integrate. HIPAA compliance option.

Healthcare Forms

Telehealth Clinical Assessment Form

Telehealth Clinical Assessment Form

Assess the medical condition and health status of the patient online by using this Telehealth Clinical Assessment Form. This form template is simple, clean, and easy to use.

Healthcare Forms

Sample Telemedicine Consent Form

Sample Telemedicine Consent Form

Collect informed consent and e-signatures from patients with a free Sample Telemedicine Consent form. Easy to customize, embed, and share. HIPAA option.

Healthcare Forms

Dermatology Telehealth Medical Examination Form

Dermatology Telehealth Medical Examination Form

Treat patients remotely. Safely collect medical info online. HIPAA compliance option. Accept photos of skin conditions. 30+ free payment app integrations.

Healthcare Forms

COVID Plasma Donation Form

COVID Plasma Donation Form

Survivors can apply to be blood donors through this online plasma donation form. Easy to customize, embed, and integrate. No coding. HIPAA compliance option.

Healthcare Forms

Medical Volunteer Application

Medical Volunteer Application

Collect medical volunteer registrations online with our free Medical Volunteer Application Form. Easy to customize and embed. Ideal for emergency response.

Healthcare Forms

Telemental Health Consent Form

Telemental Health Consent Form

Receive e-signed consent forms online with a free Telemental Health Consent Form. Easy to customize and share with patients. Opt for HIPAA compliance.

Telehealth Forms

COVID-19 Contact Investigation Form

COVID-19 Contact Investigation Form

This COVID-19 Contact Investigation Form form should be used to interview exposed contacts of confirmed cases. The form provides you with the interview scripts together with all the fields to be filled out regarding the patient and contact.

Healthcare Forms

Disclaimer

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.