Telehealth Consent Form — shared by the community

Who this template is for

Telehealth Consent Form is built for any team that needs demonstrable permission who need to record who agreed to what, and when.

• Any team that needs demonstrable permission working in consent, waivers & releases.
• Teams who need to record who agreed to what, and when without writing code or paying for a custom build.
• Anyone replacing consent claims you can't evidence months later with one structured record per enquiry.
• Respondents are customers, patients and participants — the form asks them 13 questions across 2 screens.
• Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of consent claims you can't evidence months later and turns each submission into a record your team can act on immediately.

• 8 questions are required, so submissions arrive complete instead of needing a follow-up email.
• It collects a verified email address so replies and confirmations land.
• It captures a phone number for urgent follow-up.
• It records a signature you can keep as proof of agreement.
• It pins the request to a specific date.
• Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
• Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
• Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1. 1Press “Use this template” — a fresh copy of Telehealth Consent Form lands in your workspace, ready to edit.
2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 3 conditional rules ship with it.

• Features advanced show logic: if “Where will you be located during the appointment?” is Outside the clinic's home state or country, the form dynamically exposes “Please confirm your current city and state/region”. Otherwise that question never appears.
• Features conditional hiding: if “Preferred visit type” is Phone call only, “Have you tested your camera and microphone?” is removed from the form and is never submitted.
• Features advanced show logic: if “Do you have someone with you during the visit?” is Yes, the form dynamically exposes “Name of person present”. Otherwise that question never appears.
• All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.