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Patient EMAIL/TEXT Consent Form Patient name: Patient DOB: I confirm I wish to communicate with Lauren Urban, MSW by email/text, and I understand that: it is my request to use email/text any decision
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How to fill out patient emailtext consent form
How to fill out patient emailtext consent form
01
Start by downloading the patient email/text consent form from the official website or obtain a physical copy from your healthcare provider.
02
Read the form carefully to understand the purpose and implications of giving consent to receive emails and/or text messages from your healthcare provider.
03
Fill in your personal information such as your full name, date of birth, and contact details accurately.
04
Review the consent statement thoroughly and ensure you understand the rights and responsibilities associated with granting consent.
05
Sign and date the form at the designated space to confirm your consent.
06
If applicable, provide any additional information or preferences related to email and/or text communications.
07
Make a copy of the completed form for your records.
08
Submit the filled-out form to your healthcare provider either by physically handing it over or following the specified submission process.
09
Wait for confirmation from your healthcare provider regarding the acceptance of your consent form.
10
Keep a copy of the accepted consent form for future reference.
Who needs patient emailtext consent form?
01
Any patient who wishes to receive emails and/or text messages from their healthcare provider needs to fill out a patient email/text consent form.
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