This notice is in English.
Health and clinical use
Not medical, clinical, billing, coding, legal, or professional advice. This tool organizes information you enter. It does not diagnose, treat, choose codes, determine medical necessity, calculate a safe dose for a specific patient, submit claims, or decide what a licensing board, payer, or regulator will accept. You are responsible for checking every output against current rules and your own professional judgment.
LIGHT & SALT BROADCASTING (LSB) LLC is not a HIPAA covered entity or business associate and does not sign Business Associate Agreements.
Details you keep in this tool are stored in this browser's local storage and are not sent to our server as the content of the record. You are responsible for securing this device.
Not legal advice
Not legal advice. No attorney-client relationship. LIGHT & SALT BROADCASTING (LSB) LLC is not a law firm, and this tool does not provide legal services. Templates and generated documents are general starting points. They may be incomplete or unsuitable for your situation. Have a licensed attorney review any contract, consent, notice, or Good Faith Estimate before you use it.
A telehealth consent form for the practice The template covers how the session happens, what to do if the call drops, and that telehealth is not an emergency service. It asks the client to name where they are at the start of a session. You fill in the practice details. The form stays in this browser.
Practice policies can sit beside it: cancellation notice, the no-show fee, how you use email, and the session fee. Two forms are free.
Review before you use a form
templates only, not legal advice; review with your board/attorney
Informed consent · Good faith estimate · Start the builder