Telemedicine Service Agreement

Streamline Your Telehealth Practice with a Professional Telemedicine Service Agreement

Telemedicine has transformed how healthcare providers deliver care, but ensuring patients understand the scope, limitations, and requirements of virtual consultations is essential for compliance and patient safety. This Telemedicine Service Agreement template provides healthcare practices with a clear, professional framework for onboarding telehealth patients while covering all the critical legal and operational details.

Whether you're a solo practitioner, group practice, or specialty clinic offering virtual visits, this form template helps you establish transparent expectations around technology requirements, prescription policies, emergency protocols, insurance coverage, and payment terms—all before the first consultation begins.

What This Template Covers

This comprehensive telemedicine agreement includes:

• Technology Requirements: Clearly outlines the devices, internet connection, and software patients need for successful virtual visits
• Platform Access & Privacy: Explains how patients will access your telehealth platform and what privacy protections are in place
• Prescription Limitations: Sets expectations around what medications can and cannot be prescribed via telemedicine in compliance with regulations
• Emergency Protocol: Defines when telehealth is not appropriate and provides clear instructions for medical emergencies
• Insurance & Payment Terms: Collects insurance information and explains visit fees, copays, and billing procedures
• Informed Consent: Ensures patients understand the benefits and limitations of virtual care compared to in-person visits

Why Healthcare Providers Choose Paperform for Telemedicine Agreements

Paperform is trusted by healthcare providers, telehealth platforms, mental health practitioners, and specialty clinics to create professional intake forms and service agreements that blend seamlessly into their patient experience.

With Paperform, you can:

• Match Your Brand: Customize fonts, colors, and layouts to create a professional agreement that looks like part of your practice website, not a generic legal form
• Conditional Logic for Smarter Forms: Show or hide questions based on patient responses—such as displaying state-specific prescription limitations or insurance requirements based on location
• Collect eSignatures with Papersign: Turn the completed agreement into a legally binding contract by automatically sending it for electronic signature via Papersign, keeping everything connected for compliance and audit trails
• Accept Payments Seamlessly: Integrate with Stripe, PayPal, or Square to collect visit fees, deposits, or copays directly within the agreement form
• Automate Patient Onboarding with Stepper: Use Stepper to trigger automated workflows when a patient completes the agreement—send welcome emails, create patient records in your EHR, schedule follow-up tasks for your team, or route forms to different providers based on specialty

Who This Template Is For

This telemedicine service agreement template is ideal for:

• Primary Care Physicians offering virtual consultations alongside in-person visits
• Mental Health Providers including therapists, counselors, and psychiatrists conducting teletherapy sessions
• Specialty Practices such as dermatology, endocrinology, or chronic disease management that use telehealth for follow-ups
• Urgent Care & Walk-In Clinics expanding into on-demand virtual visits
• Telehealth Platforms onboarding new healthcare providers or patients to their service
• Corporate Wellness Programs offering telemedicine benefits to employees

Compliance, Security & Peace of Mind

Healthcare data is sensitive, and Paperform takes security seriously. While Paperform is SOC 2 Type II compliant and offers enterprise-grade security features, it's important to note that Paperform is not HIPAA compliant. If your practice requires HIPAA-compliant data collection, please evaluate your compliance needs carefully or consider additional safeguards.

For practices that can use Paperform within their compliance framework, you'll benefit from:

• Data Residency Controls: Choose where patient data is stored
• SSL Encryption: All submissions are encrypted in transit
• Role-Based Permissions: Control who on your team can view sensitive patient information
• Audit Trails: Track when agreements are signed and submitted

Get Started in Minutes

With over 500,000 teams worldwide using Paperform and access to 30,000+ designer templates, you're in good company. This template gives you a head start on creating a professional telemedicine agreement that protects your practice while providing a smooth, modern experience for your patients.

Customize the questions to match your specific services, add your practice branding, integrate with your existing patient management tools, and start onboarding telehealth patients with confidence—all without needing a developer or legal software expert.

Start with this template today and turn your telemedicine onboarding into a streamlined, compliant, and patient-friendly process that sets the right expectations from the very first virtual visit.