Instructions for using Forms

We provide sample Informed Consent and HIPAA Statement forms for therapists to use. We also provide Receipt forms for electronic confirmation of the receipt of these forms. All forms in this section are in the Word or .doc format. Our Informed Consent and HIPAA Statement forms address online therapy specifically. Areas in red text must be edited to include your individual therapist information. You have permission to edit these forms to suit your needs.

We recommend that you email the following forms to the client:

  • Informed Consent
  • Informed Consent Receipt
  • HIPAA Statement
  • HIPAA Statement Receipt

Suggested steps for using these forms:
  1. Email the forms to the client in any order you wish.
  2. Ask the client to read the information, type their name and the date on both of the Receipt forms and email both forms back to you with a Subject line which reads "Informed Consent and HIPAA Statement".
  3. Save this email from the client. It will document their acknowledgement of the receipt of these forms at the date and time the email originated from them. Also save the documents they return to you.

 

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