Telehealth informed consent template

Telehealth Counselling — Informed Consent

[Practice name] · [Practitioner name, qualification, registration number]

1. What telehealth counselling involves

Telehealth means receiving counselling by video call or phone instead of in person. Sessions run for the same length and follow the same structure as an in-person appointment.

2. Benefits and limitations

Telehealth can be more convenient and accessible, particularly if travel, mobility, location or scheduling is a barrier. It also has limits: your practitioner can't observe body language and the environment the way they could in person, technology can fail mid-session, and it may not be appropriate for every presentation or every crisis situation — your practitioner will discuss with you if in-person sessions are recommended instead.

3. Privacy and technology

Sessions take place over [name the platform/software]. You're responsible for joining from a private space where you won't be overheard, and for your own device and internet security on your end. Session recordings, if any, are covered by our separate consent for AI-drafted notes — see [link/attach separately].

4. If we lose connection or there's a technical failure

If the call drops, [practitioner name] will attempt to reconnect within [X] minutes via [platform / phone as backup]. If we can't reconnect, we'll reschedule as soon as possible.

5. Emergency situations

Telehealth is not an emergency service. If you are in crisis or at immediate risk during a session, please tell me your current location at the start, and know that in an emergency I may need to contact emergency services in your area, and/or your nominated emergency contact: [name/phone]. If you're in crisis outside session hours, contact Lifeline on 13 11 14 or, in an emergency, call 000.

6. Confidentiality

The same confidentiality that applies to in-person counselling applies to telehealth sessions, and the same legal exceptions apply (risk of harm to yourself or others, court order, or as otherwise required by law). See our full privacy policy: [link].

7. Consent

I have read and understood the above, had the opportunity to ask questions, and consent to receiving counselling via telehealth on this basis. I understand I can withdraw this consent and request in-person sessions (where available) at any time.