Telehealth Informed Consent Template (Word & PDF Format)


An example of an informed consent form for telehealth services, for use by paediatric occupational therapists in South Africa.

The template was compiled from the briefing received from the Occupational Therapy Association of South Africa (OTASA).

The Word document is in editable format so that you can place it on your practice letterhead and tailor to your own practice. For your convenience we also added a fillable PDF document to get going fast!

Please note:

Built to Bloom claims no legal expertise in the compilation of this template. While relevant sources were consulted, it remains the sole responsibility of the therapist/practice to ensure that the form they use comply with all the necessary legislation and guidelines. Built to Bloom will not be liable for any losses and damages in connection with the use and application of this template. Errors and omissions excepted.

Word document download size – 38Kb.

PDF download size – 120Kb.