AI Scribe Consent Form Templates for Therapists & Health Professionals
These four AI scribe consent form templates come from real clinics already using Jane's AI Scribe. There are a few template options to choose from: a quick checkbox form, a detailed three-option consent form, a multidisciplinary option, or a short audio consent form.
Take a look and pick one out that is closest to how your practice runs. From there, download the PDF if you just need a ready-to-print version, or open the Google Doc and go to File > Make a Copy to save an editable version to your own drive.
The AI consent templates
💾 Template 1: short consent (touches on HIPAA, PHIPA & PIPEDA)
🔗 Make a copy or download directly from Google Docs
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 working across borders or those who just want something quick and easy to build on.
💾 Template 2: detailed informed consent with three options
🔗 Make a copy or download directly from Google Docs
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
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
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.
💬 If you're still thinking through how to explain your AI scribe to clients, how to talk to clients about AI scribe has example scripts and answers to the questions that come up most often.
Frequently asked questions
Do I need a separate consent form if my clients have already signed a general privacy or tech consent form?
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 practitioners in the United States. PIPEDA is Canada's federal privacy law, and PHIPA is Ontario's provincial health privacy legislation that applies to Ontario practitioners. If you're in another Canadian province, some have their own requirements worth checking.
For a fuller breakdown of how PIPEDA and provincial guidelines apply to your practice, AI Scribes and PIPEDA: What Canadian Practitioners Need to Know covers it in detail for you. Templates 1 and 2 above reference all three frameworks, so they are a great starting point for most Canadian and US-based practitioners.
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 bit of a 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, a consent form should be signed before any information is recorded or processed with an AI scribe. Some therapists include it alongside their standard intake forms, so it's handled before the first appointment. It's also a good idea to have a quick conversation in person and get verbal consent before you hit record in a session.
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 can sign digitally before their first session. 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, brand, your regulatory requirements, and the way you communicate with your clients.
