Communications Consent Agreement
- Posted On May 23rd
- In Legal
CONSENT TO COMMUNICATIONS
- This form describes the healthcare service provider’s (“Provider”) communication methods and includes:
- Your consent to the specified communication methods adopted by Provider
- Your agreement to be contacted at any time via a mobile device, phone call, SMS messages, e-mail and any other kind of communication specified by Provider, on the condition that these communications comply with privacy regulations.
- By electronically clicking “Agree” at the end of the Communications Consent Agreement, you explicitly accept the specified communication terms set forth below.
- You consent to the following communication methods:
- Appointment Reminders
- Clinical Reminders (e.g. Immunizations, Care Plans, Preventive Care)
- Clinical Communications (e.g. Results, Encounter Notes)
- Provider Business Changes (e.g. New Doctors, Location Changes, Fee Changes, Hours of Operation)
- New Patient-Provider Messages
- Prescription Refill Status
- Telehealth Visit Information
- You agree that Provider can reach you at any time via
- Patient Portal Secure Messaging
- Phone Call (incl. Automated IVR)
- Texting (SMS Messages) Communication
- Live Chat Communication
- Mobile Phone Communication
- E-Mail Communication
- Mail via Postal Service
- If your mobile number, as listed by Provider is utilized for more than one patient, you understand that all SMS communications as consented to above will be sent to that number.
- You further accept that you are responsible for notifying the Provider when your contact information changes.
- You can revoke this Communications Consent Agreement at any time by contacting the Provider.
CONTACT INFORMATION CHANGE
Agreement template made available by Bridge Patient Portal LLC. Copyright © Bridge Patient Portal LLC. All rights reserved.