Telehealth Physical Therapy Consent Form

I acknowledge that I have been offered physical therapy services through telehealth. Telehealth is the use of electronic information and telecommunication technologies to support clinical healthcare at a distance.

Potential Benefits:

• Access to physical therapy services more easily and efficiently.
• Continuity of care and convenience.

Potential Risks:

• Technical difficulties with video/audio.
• Limits to confidentiality due to technology.
• Lack of hands-on physical assessment and intervention.

Consent and Acknowledgement

By signing below, I acknowledge that I have read and understand the information above. My questions regarding telehealth services have been answered. I voluntarily consent to receive physical therapy services via telehealth.

Patient Name Date Signature