AI Scribe Consent Form Templates for Therapists & Health Professionals
If you've been meaning to put an AI scribe consent form together but keep pushing it down the list, this is your sign to knock it off in the next ten minutes. These four free templates come from real clinics already using Jane's AI Scribe so they've been tested in practice, not just drafted in theory.
Pick the one that fits how your practice runs, and just make a copy or download it from Google Docs.
The AI consent templates
💾 Template 1: short consent (touches on HIPAA, PHIPA & PIPEDA)
🔗 Make a copy or download directly from Google Docs here.
A compact, checkbox-style form that covers the essentials: what the AI does, how data is handled, and a simple yes/no/revoke consent option. Good fit for therapists who want something quick and easy to get in front of clients.
💾 Template 2: detailed informed consent with three options
🔗 Make a copy or download directly from Google Docs here.
The most thorough of the four. This one gives clients three choices: full consent, dictation-only (no session recording), or no consent at all. It covers data storage on Canadian soil, PIPEDA and PHIPA compliance, and Business Associate Agreement (BAA) coverage for US therapists. If your clients tend to ask a lot of questions before signing anything, this is the one.
💾 Template 3: multi-discipline clinic version
🔗 Make a copy or download directly from Google Docs here.
Written for mixed or multi-disciplinary settings. It uses broader clinical language ("healthcare provider," "patient") rather than therapy-specific phrasing, which makes it easier to adapt across a team. Works well for massage therapy, chiropractic, physical therapy, and clinics with more than one type of practitioner on staff.
💾 Template 4: short-form audio consent
🔗 Make a copy or download directly from Google Docs here.
One paragraph, one signature line, and you’re all done. This one is specifically about audio recording consent rather than the full scope of AI Scribe, so it works well as a standalone add-on if you already have a broader tech consent form in place and just need to cover the recording piece.
Frequently asked questions
Do I need a separate consent form if my clients already signed a general privacy or tech consent?
It depends on what your existing consent covers. If your current form mentions AI tools, session recordings, and how data is stored and deleted, you may be covered. But most general privacy consents aren't specific enough. The safest approach is to add a dedicated AI scribe consent so there's no ambiguity, especially if you're recording sessions. When in doubt, your regulatory college is the right place to check what's required in your jurisdiction.
What's the difference between HIPAA, PHIPA, and PIPEDA, and which one applies to me?
HIPAA applies to therapists and healthcare workers practicing in the United States. PIPEDA is Canada's federal privacy law, and PHIPA is Ontario's provincial health privacy legislation, which applies on top of PIPEDA for Ontario practitioners. If you're in another Canadian province, check with your provincial regulatory college, as some have their own requirements. Templates 1 and 2 above reference all three, so they work for many Canadian and US-based therapists.
Can a client withdraw their consent after they've already signed?
Yes, and all four templates make this clear. Clients can withdraw consent at any time, either in writing or verbally, without it affecting their access to care. When that happens, you'd switch to traditional note-taking for their sessions going forward. It's worth having a brief process in mind for how you'd handle that so it doesn't catch you off guard.
Does the AI scribe consent form need to be signed before the first session?
Yes, it should be signed before using AI Scribe with a client. Consent should be obtained before any session is recorded or processed. Some therapists include it alongside their standard intake forms, so it's handled before the first appointment. If you're on Jane, you can add it directly to your client's online intake form so it gets signed digitally before they even arrive. And if you're not sure whether to use ambient recording or dictation mode, this article breaks down the difference for you.
A note if you're already using Jane
If you're already using Jane's AI Scribe, you can add any of these consent forms directly to your client intake flow in Jane. That way, clients sign before their first session rather than in the waiting room, which is better for everyone. Here's how to add intake forms in Jane and how to work with the consents section.
Templates pulled from real clinics using Jane's AI Scribe. Make sure to customize your form in order to match your practice's language, your regulatory requirements, and the way you actually talk to your clients.
