---
title: COVID-19 Telehealth Consent Form Download
description: Given the unprecedented need for urgent telehealth solutions, we are offering this sample Telehealth Consent form for your organization’s use during this pandemic crisis period.
image: https://files.norcal-group.com/hubfs/NORCAL_ExchaNGe-Pandemic_Consent_thumb-.jpg
---

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#### [***PANDEMIC:*** COVID-19](https://www.norcal-group.com/pandemic) RESOURCES & UPDATES

# COVID-19 Telehealth Consent Form Download

**Posted/Updated on 2/10/21 2:30 PM**

The NORCAL Group COVID-19 Telehealth Consent Form can be used to facilitate the informed consent process prior to a telehealth encounter. In addition to using these forms document the telemedicine /telehealth informed consent process, including that the patient agrees to and understands the limits of confidentiality when communicating via an electronic medium and that it may be determined that telemedicine or telehealth is not appropriate for the diagnosis and treatment of his or her condition.

*The information provided on this site offers risk management recommendations and resource links. Guidance and recommendations contained in this website are not intended to determine the standard of care, but are provided as risk management advice only. The ultimate judgment regarding the propriety of any method of care must be made by the healthcare professional. The information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney. NORCAL Group makes no representation regarding compliance with state or federal law by offering these resources. These documents and links are provided for your convenience and reference only, and the provision of these materials does not mean NORCAL Group is affiliated or associated with these organizations.*

Telehealth Consent Form  
Please find an unbranded, [Word *.doc version](https://files.norcal-group.com/hubfs/Resources/Telemedicine_Informed-Consent_COVID-19.docx) and a [Fillable PDF *pdf version](https://files.norcal-group.com/hubfs/Resources/Telemedicine_Informed-Consent_COVID-19-PDF.pdf) available below for download.

NOTE: *PDF should be downloaded and saved locally for digital signature option.*

[![Download Word: Informed Consent Template](https://files.norcal-group.com/hubfs/Resources/Telemedicine_Informed-Consent_COVID-19_thumb.png)](https://files.norcal-group.com/hubfs/Resources/Telemedicine_Informed-Consent_COVID-19.docx)   [![Download Fillable PDF: Informed Consent Template](https://files.norcal-group.com/hubfs/Telemedicine_Informed-Consent_COVID-19-PDF_thumb.png)](https://files.norcal-group.com/hubfs/Resources/Telemedicine_Informed-Consent_COVID-19-PDF.pdf)

 Topics: [COVID-19](https://www.norcal-group.com/pandemic/tag/covid-19)

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