Consent for Email / Text Message Communication of Patient Health Information
As a health care provider, providing access to your records in a secure manner while balancing ease of access is important to us. If you have requested that we transmit a copy of your records, which may contain your Protected Health Information (PHI), via email or text message, we are required by law to notify you that email/text is not a completely secure means of communication due to the fact that messages can be addressed to the wrong person or messages can be intercepted during transmission by a third party.
If you acknowledge the above risks and still would like for us to send your information via email/text message, please print clearly, sign and complete the consent below. Please note – due to some email providers, certain size files may not be transmitted. In the event that there is trouble with transmission, we will mail a copy of your records to your home address.
Disclaimer: Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed. Please do not include personal medical information in any emails you send to us. No one can diagnose your condition from email or other written communications, and communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.