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This informed consent from the Genesis Counseling Center provides a good example of a form that is customized for online therapy. If you offer exclusively online therapy services, you can have just one consent form that includes everything related to teletherapy within it.Getting informed consent from patients who choose telehealth or telemedicine mental health appointments like online counseling. Clinical Care Consultants (CCC) Online Psychotherapy services are not for minors. Identify Verification. Online Therapy Informed Consent. Informed Consent for Therapy Services – Adult. I understand that the laws that protect the confidentiality of my medical information also apply to online counseling or psychiatry services. If you anticipate becoming involved in a court case, I recommend that we discuss this fully before you waive your right to confidentiality. Please read through the following informed consent agreement.