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AI Scribe Consent Form Template
An AI scribe consent form tells your patient what the scribe records, where their information goes, and that they can say no. Then it records their answer. Use it on paper, or read the short script aloud and add the line for the chart. Check what your college expects below.
For clinicians in Canada.
- Free, no account needed
- Word and text downloads
- Two filled examples
Blank AI scribe consent template
FreeAI SCRIBE CONSENT FORM [Clinic name] [Address and phone] Patient: [Full name] Date of birth: [Date] Clinician: [Name and credentials] WHAT THE AI SCRIBE DOES Your clinician uses an AI scribe called [AI scribe name] to help write visit notes. It listens to your visit and writes a draft of the note. Your clinician reads every draft, corrects it, and signs the final note. The AI scribe does not make decisions about your care. WHAT IS RECORDED Captured: [Audio of the visit, a written transcript, or both] Others in the room: [Anyone else whose voice may be captured, e.g. a family member or interpreter] WHERE IT IS PROCESSED AND STORED Vendor: [Company that runs the AI scribe] Location: [Where the audio and transcript are processed and stored, e.g. in Canada] Training: [Whether your information is used to train the AI, e.g. not used] Deleted: [When the audio and transcript are deleted, e.g. once your clinician signs the note] Kept in your health record: [The signed note only, or anything else the clinic keeps] RISKS AND SAFEGUARDS The draft can contain mistakes, leave things out, or reflect bias. Any digital system carries some privacy risk. Safeguards: [e.g. encryption, access limited to your care team, a privacy agreement with the vendor] Your clinician checks every note before signing it. YOUR CHOICE Using the AI scribe is your choice. Saying no will not change your care. You can ask your clinician to pause or stop it at any time, and you can change your mind at a later visit. Without it, your clinician takes notes the usual way. Questions: [Who to ask, e.g. the clinic's privacy contact and phone] CONSENT I agree to the use of the AI scribe: [Yes or no] This consent covers: [This visit only, or this and later visits until I say otherwise] Name: [Patient's name, or the substitute decision-maker's name] Relationship to the patient: [If not the patient, e.g. parent or guardian] Signature: [Signature, or verbal consent recorded by the clinician] Date: [Date] FOR THE CLINICIAN Script, before you turn it on: I use an AI scribe called [AI scribe name] to help write my notes. It listens to our conversation and drafts the note, and I check and correct all of it before I sign. The [audio or transcript] is processed [where] and deleted [when]. It can make mistakes, and any computer system has some privacy risk. You don't have to agree, and saying no won't change your care. You can ask me to stop it at any time. Is it OK if I use it? At later visits: Just a reminder that the AI scribe is on today. Tell me any time if you'd like it off. Line for the chart: AI scribe: [AI scribe name] used with [verbal or written] consent from [the patient, or the name and relationship of the substitute decision-maker] on [date]. Explained its purpose, that I review every note, what is recorded, where it is processed and when it is deleted, the risks of errors and to privacy, and the right to decline or stop at any time. Consent covers [this visit, or later visits until withdrawn].
Use it for
- Family practice
- Specialist clinics
- Virtual visits
- New patients
- Clinic privacy policies
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
AI scribe consent example: verbal consent at a family practice visit
Family physician, in-person follow-up, first visit with the scribe
Before the visit
The clinic sent its one-page AI scribe information sheet with the appointment reminder and offered a printed copy at check-in. The patient, a 58-year-old man in for a blood pressure follow-up, had read it.
What you say
“Before we start, I’d like to ask you about something new. I use an AI scribe called [AI scribe name]. It listens to our conversation and writes a draft of my note, and I read and correct every note before I sign it. The audio is processed in Canada and deleted once I sign the note. It can make mistakes, which is why I check it, and like any computer system it carries some privacy risk. You don’t have to agree, and saying no won’t change your care. You can ask me to stop it at any point. Is it OK if I use it today and at your next visits?”
The patient’s answer
He asked whether the recording would go into his chart. Told him no: only the signed note goes in, and the audio is deleted once the note is signed. He agreed to use at this and later visits.
Line for the chart
AI scribe: [AI scribe name] used with the patient’s verbal consent on October 14, 2026. Explained its purpose, that I review every note, that the audio is processed in Canada and deleted once the note is signed, the risks of errors and to privacy, and his right to decline or stop at any time. Consent covers later visits until withdrawn.
At the next visit
Before turning it on: “Just a reminder that the AI scribe is on today. Tell me any time if you’d like it off.” Chart: AI scribe reminder given; patient agreed.
AI scribe consent example: a patient asks to stop partway
Family physician, in-person visit, consent given at an earlier visit
The situation
A 34-year-old woman who agreed to the AI scribe on October 2, 2026, came in on October 20 about poor sleep. About 10 minutes in, she said she wanted to talk about problems at home and asked whether the scribe could be turned off.
What you say
“Of course. I’m turning it off now. It’s off, and nothing from here on is captured. I’ll write this part of the note myself, and nothing about your care changes.”
What you do
Stopped the scribe and showed her that it was off. Finished the visit and wrote that part of the note without the scribe. Reviewed the scribe’s draft of the first 10 minutes as usual before signing.
Line for the chart
AI scribe stopped at the patient’s request about 10 minutes into the visit. The rest of the visit was documented by the clinician without the scribe. Care unchanged.
At the next visit
Asked before starting it: “Last time you asked me to turn the scribe off. Would you like it on today, or off?” She chose off. Chart: patient declined the AI scribe today; visit documented without it.
What Canadian guidance says. Checked October 2026.
The CMPA notes that most colleges expect consent, accountability for the accuracy of the note, and awareness of the risks to privacy and of bias. How consent is given differs by province. Below are the CMPA’s advice and 4 colleges’ guidance; if you aren’t a physician, check your own college too.
Across Canada
The CMPA advises getting consent before any recording, explaining its purpose and the privacy and accuracy risks in plain language, and documenting the discussion in the chart with any form you used. Review every note the scribe drafts.
Ontario
The CPSO says to tell patients how AI will be used, and to get their consent before recording conversations. OntarioMD’s AI scribe patient consent toolkit has a sample form and a script.
Québec
The Collège des médecins du Québec (CMQ) says explicit consent is mandatory before you use an AI scribe, and a waiting-room poster isn’t enough. It also asks you to use a scribe certified by Santé Québec, and to destroy recordings and verbatim transcripts once you have reviewed and signed the note.
Alberta
The CPSA does not recommend implied consent: tell patients how AI is used, get verbal or written consent, document it, and make clear they can decline. Submit or update a privacy impact assessment with Alberta’s Information and Privacy Commissioner when you bring in an AI tool.
Nova Scotia
If the scribe keeps no recording, knowledgeable implied consent is enough, and it lasts across visits; keeping a recording needs express consent. The CPSNS suggests telling patients before the appointment, such as with signs, brochures, or at check-in.
What goes in each part.
What the AI scribe does
Tell the patient, in plain words, what the tool is for, and that you stay responsible for the note.
- The name of the AI scribe
- That it listens to the visit and drafts a note
- That you read, correct, and sign every note
- That it does not make decisions about their care
Avoid: Calling it dictation. An AI scribe summarizes the conversation, and some suggest content, so patients should know it does more than type.
What is recorded
What the scribe captures, and whose voices. Tools differ, so fill this in from your vendor’s documentation.
- Audio, a transcript, or both, and whether any audio is kept
- Anyone else in the room whose voice is captured
- Whether you can pause it during the visit
Avoid: Saying nothing is recorded when the tool keeps audio, even for a short time.
Where it’s processed and stored
The CMPA notes that some vendors store information on servers inside Canada and some outside it. Patients should know where theirs goes, and for how long.
- Who processes it, and where: in your province, elsewhere in Canada, or outside Canada
- Whether it is used to train the AI
- When the audio and transcript are deleted
- What goes into the chart: the signed note, and anything else you keep
Avoid: Copying these answers from a brochure. Take them from your vendor agreement.
Risks and safeguards
The CMPA advises explaining both kinds of risk, privacy and accuracy, in plain language.
- Errors: the draft can misread, invent, or leave out details, or reflect bias
- Privacy: any digital processing carries some risk
- Your safeguards, such as encryption and limits on who can see the data
- That you review every note before it is signed
Avoid: Calling the tool risk-free or fully secure.
The patient’s choice
Saying no should be easy, and it must not change the patient’s care.
- That agreeing is voluntary
- That saying no will not affect their care
- That they can ask you to pause or stop at any time, and change their mind at a later visit
- Who to ask with questions
Avoid: Turning the scribe on, then asking. Ask first, so the patient can say no before anything is captured.
Consent and the chart line
Record who agreed, how, and when. The CMPA advises documenting the consent discussion in the chart, with any form you used.
- Who agreed: the patient, or a substitute decision-maker and their relationship to the patient
- How: verbal and recorded by you, or a signed form
- The date, and whether it covers later visits
- The name of the AI scribe: the CMQ recommends naming it in the note
Avoid: Relying on a waiting-room poster. In Québec the CMQ says a poster isn’t enough; elsewhere, check what your college accepts.
Common mistakes, and how to avoid them.
No line in the chart
One line covers it: who agreed, how, when, and what you explained. Scan in any signed form.
Filling in the form from a brochure
Take where data is processed, whether it trains the AI, and when it is deleted from your vendor agreement. The CMQ also asks you to check that the vendor doesn’t keep recordings longer than needed.
Signing the draft unread
AI scribes can invent, misread, or leave out details. Read every note before you sign it: it is your record.
Forgetting who else is in the room
A parent, partner, or interpreter is captured too. Tell them the scribe is on before you start.
Not asking again when things change
The CMQ recommends new consent when a visit turns to a more sensitive topic than the one consent was given for, or after a major change to the tool, such as data newly used for training outside Canada.
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Frequently asked questions.
Do I need patient consent to use an AI scribe in Canada?
Yes. The CMPA advises consent before any recording, and the CPSO in Ontario and the CMQ in Québec say the same. How it’s given differs: the CMQ requires explicit consent and says a poster isn’t enough, while in Nova Scotia knowledgeable implied consent is enough when the scribe keeps no recording.
Do I need consent at every visit, or just once?
The CMQ says to get informed consent at the first visit, covering later visits unless the patient objects; after that, a reminder that the scribe is on is enough, and gives them the chance to withdraw. It recommends asking again before a more sensitive topic, or after a major change to the tool that raises privacy risk. In Nova Scotia, implied consent lasts across visits.
Is verbal consent enough, or do I need a signed form?
Alberta’s college (CPSA) accepts verbal or written consent, documented in the chart. The CMPA advises documenting the discussion and keeping any form you used. Santé Québec’s FAQ on AI scribes accepts either, and recommends written consent for practical reasons.
How does consent work for children, or with a substitute decision-maker?
The AI scribe guidance on this page sets no separate rule. Apply the consent rules you already follow in your province for capable minors and substitute decision-makers, and chart who agreed and their relationship to the patient.
What if an interpreter or family member is in the room?
Their voices are captured too, so tell them the scribe is on before you start, and give the explanation through the interpreter. In Québec, Santé Québec’s FAQ says every third party present, such as a family member, caregiver, or interpreter, must give explicit consent before recording.
Should I pause the scribe for sensitive topics?
If the patient asks, yes: stop it, tell them it’s off, and write that part yourself. The CMQ recommends fresh consent when a visit will cover a more sensitive topic than the one consent was first given for, such as intimate partner violence.
Show all questions
What happens to the recording and the transcript?
It depends on the tool; the CPSNS notes that most AI scribes keep no recording. The CMQ treats recordings and verbatim transcripts as draft aids to destroy once you have reviewed and signed the note, and says any not yet deleted can be released on an access request. The CMPA says most colleges don’t address it, so follow your college and any facility policy.
Is this AI scribe consent template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write the consent line into my visit note?
Yes, when you ask for consent aloud. Vero drafts the visit note from the conversation, including the consent you discussed, for you to review and sign. If you use Vero, its own patient consent forms are on the consent forms page.
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If you use Vero: simple and detailed forms in English and French, as PDFs.
PIPEDA and AI scribes
What Canadian clinics should check about consent, storage, and retention.
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Uses, workflow, and limits, and what stays the clinician’s job.
Your template. Filled in from the visit.
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