Communication Consent

Communication Consents – Email Consent Form

Purpose: This form is used to obtain your consent to communicate with you via email regarding your Protected Health Information (PHI). Hill Family Dental offers patients the option to communicate by email. However, transmitting patient information by email comes with certain risks that patients should consider before giving consent.

Hill Family Dental will use reasonable means to protect the security and confidentiality of email communications. However, we cannot guarantee the complete security of email communication and will not be held liable for any unintended or inadvertent disclosure of confidential information.

Acknowledgment and Consent: I acknowledge that I have read and fully understand this consent form. I am aware of the potential risks associated with communicating by email with Hill Family Dental. I hereby give my consent under the conditions outlined above. Any questions I had have been answered to my satisfaction.

Text Message to Mobile Consent Form

Purpose: This form is used to obtain your consent to communicate with you via mobile text messaging regarding your Protected Health Information (PHI).

Hill Family Dental offers patients the option to communicate through mobile text messaging. However, transmitting patient information via text messaging carries certain risks that you should consider before granting consent.

Hill Family Dental will take reasonable precautions to protect the security and confidentiality of information sent and received through mobile text messaging. However, we cannot guarantee the absolute security of these communications and will not be held liable for any unintentional disclosure of confidential information.

Consent Statement: I acknowledge that I have read and fully understand this consent form. I understand the risks associated with communicating via mobile text messaging with Hill Family Dental, and I consent to the terms outlined above. I confirm that any questions I had regarding this consent have been answered by Hill Family Dental.