Sample Consent Forms
Telemedicine encounters will often require a consent form. These can be tailored to your individual needs.
- General Patient Consent
- General Dermatology Form
- Native American Telecardiolgy Consent (IHS/Arizona Telemedicine Program)
- Consent to Treatment & Release (Kentucky Telecare)
- Consent to Participate in a Telemedicine Consultation (Marquette General Health System)
Sample Clinical Consulting Forms
- Project Outreach Teledermatology Consultation Form (ATA Teldermatology SIG)
- Teledermatology Acne/PFB Patient Information Form (ATA Teledermatology SIG)
- Teledermatology Alopecia Patient Information Form (ATA Teldermatology SIG)
- Teledermatology Non-Pigmented Skin Lesion Patient Information Form (ATA Teledermatology SIG)
- Teledermatology Pigmented Lesion Patient Information Form (ATA Teledermatology SIG)
- Teledermatology Rash Patient Information Form (ATA Teledermatology SIG)
- Clinical Documentation Examples
- Teledermatology History Form General (ATA Teledermatology SIG)
Sample Clinical Consultation Protocols & Forms
- Teledermatology Protocol Real-Time (Arizona Telemedicine Program)
- Teledermatology Protocol Store-Forward (Arizona Telemedicine Program)
Sample Site Assessment Documents
- Initial Site Assessment
- Readiness Assessment Template
- NN/LM Community-Based Resources & Assets Inventory
Business & Finance Tools & Documents
- Sample Network Membership Agreement (Arizona Telemedicine Program)
- Sample Business Agreement (AFHCAN)
- ATA Business & Finance SIG Business Plan Template
- ATA Business & Finance SIG Business Plan Template Summary
- ATA Business & Finance SIG Business Plan Budget Spreadsheet
- ATA Business & Finance SIG Telehealth Service Delivery Models
Sample User Satisfaction Forms