Telepsychiatry Consent Form

Introduction

This form is intended to obtain your consent to participate in telepsychiatry services. Telepsychiatry involves the delivery of psychiatric assessment and care via telecommunications technology (such as video conferencing).

Benefits & Risks

• Access to psychiatric care from remote locations.
• Potential limitations due to technology or confidentiality risks.

Confidentiality

All information shared during the telepsychiatry session will be kept confidential, with exceptions as required by law.

Patient Rights

• The right to withdraw consent at any time.
• The right to refuse telepsychiatry services.

Consent

By signing this form, you acknowledge that you have read and understand the information provided above and consent to participate in telepsychiatry sessions.

Patient Name: Date: Signature: