Do you need a written form?

In most cases, verbal consent is enough — no state requires that AI scribe consent be in writing. A written form is an optional extra step that some clinics prefer, and it's a sensible one in all-party consent states (such as California, Illinois, Florida, Nevada, and Washington) or wherever your own clinic policy calls for a signed record. For the full picture of when and how to obtain consent, see Do I Need Patient Consent to Use an AI Scribe? and the state-specific guides linked there.

Step-by-step guide

1. Locate the consent form. Find the Chartnote AI Scribe Consent Form attached at the end of this article and click to download it.
2. Choose your language. The form includes an English version and a Spanish version. Use whichever fits your patient — or keep both on hand.
3. Customize the form. The file is a Word document (.docx) that you can edit. Replace the placeholders with your clinic name and provider details, and save your changes. Because consent forms can carry legal weight, have your legal or administrative team review the wording before using it.
4. Print it, or use it electronically. Print the form for patients to read and sign in person. For telehealth or phone visits, you can collect an electronic signature or, where appropriate, document verbal consent in the visit note instead.
5. Explain it to your patient. Before they sign, briefly explain what Chartnote AI Scribe is, that the visit will be audio-recorded to help create the note, how their information is protected, and that they can decline or stop at any time.
6. Obtain and store consent. Have the patient read and sign, and keep the signed form (or your documentation of verbal consent) in the patient record.

What the form covers

The updated form is written to capture the things that matter for a recording consent:

• Clear consent to the audio recording and transcription of the visit to create clinical notes.
• A statement that participation is voluntary and the patient may decline or withdraw at any time without affecting their care.
• A reminder that the provider reviews and finalizes every note, and that the recording/transcript is a documentation aid rather than the official record.
• A line for a family member, caregiver, or interpreter who is part of the conversation to also agree (important in all-party consent states).
• HIPAA and confidentiality assurances.

Related resources

• Do I Need Patient Consent to Use an AI Scribe? — the main guide, including verbal scripts and a state-by-state reference.
• Printable Clinic Notice and Provider & Staff Guide — attached to the main guide above, for posting in your clinic and briefing your team.

Customizing and using this form appropriately helps maintain transparency and trust with your patients. If you have questions, please contact our support team.

This is a sample form and general information, not legal advice. Recording-consent laws vary by state and change frequently; confirm your approach with qualified legal counsel.