Telepsychiatry Consent Form for Adolescents
Introduction
Confidentiality
Technology and Security
Risks and Benefits
Parental/Guardian Consent
Voluntary Participation
Contact Information
I, the adolescent, have read and understood the above information and agree to participate in telepsychiatry sessions.
I, the parent/legal guardian, have read and understood the above information and consent to my child’s participation in telepsychiatry.
Adolescent Name
Signature (Type Name)
Date
Parent/Guardian Name
Signature (Type Name)
Date