Client Consent Template

Use this template to obtain informed consent from your clients for AI-assisted clinical documentation. You can print this page or save it as a PDF.

To save as PDF: Click "Print", then select "Save as PDF" as the destination in your browser's print dialog.

Grounded Scribe

AUDIO RECORDING & AI DOCUMENTATION CONSENT

This practice uses an AI tool called Grounded Scribe to help write clinical notes. Please read the points below before signing.

With your consent

Your session will be audio recorded.
The recording is sent securely to an AI service for transcription, then deleted within minutes — the audio is not kept.
The AI helps your practitioner draft your clinical notes from the transcript.
Your practitioner reviews every note before it goes into your record.
Your practitioner may also ask the AI questions about your care — for example, to summarise progress or draft a letter. The AI reads only notes your practitioner has already finalised.
Your data is never used to train AI models.
All clinical decisions stay with your practitioner.

Where your information is stored

Transcription happens overseas with a trusted provider, and the audio is deleted straight after. Your clinical notes and records are stored only on Australian servers.

Your Rights

Withdraw consent at any time. Your care will not be affected.
Request alternative recording or note-keeping methods.
Request access to your information under the Australian Privacy Principles.

I consent to audio recording and AI-assisted documentation as described above

I do not consent

Practice Name

Practitioner Name

Client Name

Date

Client Signature

Suggested Verbal Consent Script

For practitioners who prefer verbal consent or as a supplement to this written form.

“With your permission, I'd like to record our session and have an AI help me write up the clinical notes. The recording is processed by a secure AI service and deleted within minutes — the audio isn't kept. Your notes are stored on Australian servers and I review everything before it goes into your record. I may also ask the AI questions about your care to help me summarise your progress or draft a letter. You can say no at any time, and it won't affect your care. Are you comfortable with that?”

This consent form template is provided by Grounded Scribe Pty Ltd (ABN 69 695 177 818). Practitioners should adapt this template to suit their specific practice requirements and professional obligations.

For more information, visit groundedscribe.com/privacy | groundedscribe.com/security