Patient Consent & Related Forms
The Northwest Regional Telehealth Resource Center
- Diabetes Education Consent and Observation Form (NORTHWEST TELEHEALTH)
- Diabetes Education Consent Form (NORTHWEST TELEHEALTH)
- Diabetes Education Patient Referral Form (NORTHWEST TELEHEALTH)
- Diabetes Education Physician Order Form (NORTHWEST TELEHEALTH)
- Diabetes Education Provider Letter (NORTHWEST TELEHEALTH)
- Mental Health Patient Consent Form (UTAH TELEHEALTH)
- Patient Consent Form (NORTHWEST TELEHEALTH)
- Patient Consent Form (NRTRC – NEW!)
- Patient Consent Form (REACH)
- Patient Encounter Form Instructions (NRTRC – NEW!)
- Patient Rights for Telehealth Encounters (NRTRC – NEW!)
- Stroke Patient Consent Form (UTAH TELEHEALTH)
- Video Recording Photo Release (NIRHC)
- Video Recording Photo Release (UTAH TELEHEALTH)
- Video Recording Photo Release Non Commercial (NIRHC)