Document templates

Breakthrough makes the following document templates available for you to customize for your profile.

Please note Breakthrough does not guarantee that the documents are appropriate for your state or licensure. By using any of these documents, you agree to indemnify Breakthrough from any damages that you incur by using them.

Notice Of Privacy Practices

General Consent To Treatment

Telemedicine Informed Consent

Assignment of Benefits

All Documents Above

How to use the templates

1. Right-click the filename and save the PDF to your computer.

2. Open the PDF with Adobe Reader.

3. Enter your name at the top of the document.

4. Save.

5. On Breakthrough, go to Edit Profile > Documents and upload the saved document.