AI Consent Disclosure Template
From Golden Bee Billing Services, LLCThis boutique GBBS-branded consent form helps practices disclose the use of artificial intelligence (AI) tools in a HIPAA-compliant, transparent, and client-friendly way. Use it as part of your intake packet or documentation workflow.
✔️ HIPAA & HITECH-compliant language
✔️ Clearly outlines what AI is—and isn’t—used for
✔️ Ready to print or upload to your EHR
✔️ Beautifully branded with GBBS colors and footer
✔️ Includes signature lines for client consentFormat: Printable PDF
Price: $15.00 (tax included)Tax is included in the listed price. No refunds on digital products. Download available immediately after purchase.
© 2025 Golden Bee Billing Services, LLC – For purchaser use only. Not licensed for resale, distribution, or use by third-party billers.
AI Use Disclosure Form (2025 Edition)
© 2025 Golden Bee Billing Services, LLC
All rights reserved. This document is an original work created by Golden Bee Billing Services, LLC and may not be copied, resold, or distributed without written permission.This template is intended for informational and administrative use only. It does not constitute legal advice and should be reviewed or customized to fit your individual practice policies and state regulations before use.
Licensing Your purchase includes a single-use commercial license for use within one private practice. You may print, fill, and digitally store the form for client use within your practice, but redistribution, resale, or reproduction for others is not permitted.
Pricing Note All prices listed in The Hive Shop include applicable taxes. No additional fees will be added at checkout.