Signing example
Sign a telehealth consent form online
A telehealth consent form has to be signed before the call, record where the patient will physically be in case of an emergency, and show they understood the recording and privacy terms. This two page consent for a GP video appointment on 8 October 2026 was signed on 4 October, with the patient's typed location and two X marks on page 1.
The document, with its fields
The pages as a signer sees them, with the signature, name, title and date fields placed where each party has to complete them.
Telehealth Consent
Your appointment
| Patient | Bronte Kealy, date of birth 9 November 1995, patient number GMC-48812 |
|---|---|
| Doctor | Dr Owen Prendergast, general practitioner |
| Appointment | Thursday 8 October 2026 at 10:30 am (Queensland time), 15 minutes, by video |
| Reason for visit | Review of blood test results and repeat prescription |
| Fee | Bulk billed for this consultation. The clinic tells you before the call if a private fee would apply |
How the video call works
About ten minutes before the appointment the clinic sends a text message with a link to its secure video platform. The link opens in a web browser on a phone, tablet or computer, with no app to install and no account to create. The doctor joins from a private consulting room at the clinic. If the video does not connect within five minutes of the appointment time, the doctor phones you on the mobile number in your record instead, and the consultation continues by phone.
Where you will be during the call
The doctor needs to know where you physically are, so that help can be sent to the right place if something urgent happens during the call. Please type the address or location you will be at, in your own signing session.
Recording and privacy
The clinic does not record video consultations. The doctor writes notes in your medical record as for any appointment. Please type an X in each box below to confirm you agree. An empty box means you would like to talk to the clinic about it before the call.
| Agree | Statement |
|---|---|
| I understand the clinic does not record the call, and I will not record it, or take screenshots of it, unless the doctor agrees at the start of the call. | |
| I have read how the clinic handles my information on page 2, and I understand a video call carries some privacy risk that an in person visit does not. |
How your information is handled
- The video platform encrypts the call between your device and the clinic. No video, audio or chat is stored on the platform after the call ends.
- The doctor's notes, any prescription and any referral are stored in your medical record at the clinic, under the Australian Privacy Principles and the clinic's privacy policy, exactly as for an in person visit.
- Prescriptions are sent as an electronic token to your mobile by text message, unless you ask for a paper script to be posted.
- Choose a private place for the call. Other people in the room may hear what you discuss. You may ask to stop the call and book an in person appointment at any time.
When telehealth is not suitable
A video consultation cannot replace a physical examination. If the doctor decides during the call that you need to be seen in person, the clinic will book you an appointment, usually the same or next day, and you will not be charged for a second consultation for the same problem.
In an emergency
Your consent
I consent to having my consultation with Dr Prendergast by video on 8 October 2026, on the terms above, and to the clinic using this consent for future video consultations until I tell the clinic otherwise. I understand I can withdraw this consent and ask for an in person appointment at any time.
Who signs what
- Bronte Kealy, patient
- Her location during the call, typed on page 1 · Two X marks: recording understood, privacy read · Signature and stamped date on page 2 · Email link
The signing journey
Step 1
Five fields, one patient
A text field for her location and two checkboxes on page 1, then a signature and date on page 2.
Step 2
Sent days before the appointment
The clinic sends the envelope when the appointment is booked, so consent is on file well before the doctor joins the call.
Step 3
She types where she will be
14 Hume Street, East Toowoomba goes on the ruled line, in her own session. The clinic cannot pre fill it.
Step 4
Two marks, one signature
She types an X beside the recording statement and the privacy statement, signs on page 2 and accepts the electronic signing consent.
Every field, and who fills it
Bronte Kealy is the only signer. On page 1 she types her location during the call on the ruled line under the heading Where you will be during the call, then types an X in the Agree column beside the recording statement and the privacy statement. On page 2 she signs under the consent paragraph and the date is stamped beside her signature. The appointment time, Dr Owen Prendergast's name, the bulk billing note and the emergency box are printed in the PDF.
How to adapt this envelope
A psychology practice running many video sessions can keep the consent standing until withdrawn, as this one does, and send it once at intake. A clinic that does record consultations for a stated purpose replaces the first statement with a recording consent and keeps it as its own box. For a child, the parent signs and the location line names where the child will be.
What makes this valid
In Australia the Electronic Transactions Act 1999 recognises an electronic signature that identifies the signer and shows intention by a reliable method. The Medical Board of Australia's guidelines on telehealth consultations expect doctors to consider whether a video consultation is clinically appropriate and to protect the patient's privacy. Health information is handled under the Australian Privacy Principles, which page 2 summarises for the patient.
What makes this signing flow work
The location is typed by the patient
The doctor needs to know where to send help if something goes wrong on the call. That address can only come from the patient, so it is a text field she fills herself, and it sits in the signed PDF the doctor opens before the call.
Signed before, not during
The certificate shows she signed on 4 October 2026, four days before the 10:30 am appointment printed on page 1. A consent signed at the start of a call is harder to rely on than one already on the record.
Recording and privacy get separate marks
One statement covers recording and screenshots, the other the privacy terms on page 2. Two boxes mean the record shows each was accepted on its own, and because both are required the portal will not let her finish with either one empty.
Questions people ask
Why does a telehealth consent ask where I will be?
If you become unwell during the call, the doctor has to send help to where you are, not to the address in your record. Typing the location before the call puts it in the signed document the doctor has open, and it can be confirmed again at the start of the consultation.
Can I sign the telehealth consent on my phone?
Yes. On a narrow screen the portal moves the location field and both boxes into a Complete your details panel above the document. You fill them there, draw your signature with a finger and finish, with no account and no app.
Does signing mean the clinic will record my call?
No. The first statement says the clinic does not record video consultations and asks you not to record either, unless the doctor agrees at the start. Your X confirms you understood that. The doctor still writes clinical notes in your record as for any visit.
What does the certificate show about when I signed?
It prints the time you signed and the time you accepted the electronic signing consent, both in UTC, with your IP address and the hash of the document. Here that is 4 October 2026, which the clinic can set against the 8 October appointment printed in the consent.
Do I need to sign again for my next video appointment?
The consent paragraph says it applies to future video consultations until you tell the clinic otherwise, so one signed copy covers later calls. If the clinic's terms change, it sends a new version as a new envelope and you sign that.
What if I decline the consent?
The envelope moves to declined and the clinic is emailed with any reason you typed. Your appointment can be changed to an in person visit, and the clinic can void the envelope and send a revised consent if something in it was the problem.
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