Resource Library
Consent Forms
Dental Telehealth Consent
A consent template for video consults and remote patient touchpoints, including limitations, privacy, technology risks, and escalation.
Best used for
Where this helps inside the clinic.
Relaya Video
Remote consultations
Post-op reviews
Treatment discussions
Resource structure
What the resource should help your team capture.
Service Description
Explain the remote care format.
Video consult
Photo review if applicable
Limitations
When in-person care is required
Privacy and Technology
Explain data and technology considerations.
Platform used
Privacy risks
Recording policy
Emergency limitations
Patient Responsibilities
Clarify how the patient should participate.
Accurate information
Private location
Connection quality
Emergency instructions
Consent
Document agreement.
Patient signature
Date
Guardian if applicable
The Practice Presence for Dental Clinics
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