E-mail and Cell Phone Authorization

E-mail and text messaging offers an easy and convenient way for patients and providers to communicate. We recognize there are times when e-mail and text messaging are more effective forms of communication.

Please remember that there are important differences between posting information electronically and talking on the telephone or having an office visit.

Emails and text messages are not the same as phone calls to our office and we handle these communications very carefully with your privacy in mind. If there is any sensitive or personal information you need to share, please send us a message through your patient portal. Likewise, we will share private information, documents, and such with you in your patient portal or we may send you an encrypted email. Below are our policies for contacting us using email and text messaging.

Please check YES next to each statement to indicate you understand that…

In order to inform you of your lab or test results in the most time-effective manner, we would like to call you on your cell phone to speak with you. We will never leave a voice message with lab or test results, or other sensitive information. If we are not able to reach you, we will always leave you a message for you to call our office back.

I authorize Essence for Wellness staff members to call me on my cell phone or to leave me a message on my voice mail. *

My cell phone number is: *

E-mail and/or text messaging is never, ever, appropriate for urgent or emergency problems! Please use the telephone for urgent matters and dial 911 for emergencies. *

E-mail and/or text messaging are great for asking quick questions that don’t require a lot of discussion. Appropriate uses of e- mail or text include prescription refill requests, appointment scheduling requests, and billing questions. All of which may also be communicated via your patient portal. *
E-mail and/or text messaging should not be used to communicate sensitive personal or medical information. *

E-mail and/or text messaging is not strictly confidential. Our staff may read your emails to handle general inquiry and non- clinical matters. You should also know that if sending emails from work, your employer has a legal right to read your email if he or she chooses. *

E-mail and/or text correspondence may become a part of your medical record. A copy of text and email transcripts may be printed and put in your chart for future reference. *

By checking YES, I confirm I authorize Essence for Wellness staff members reach me electronically. I have read the above information and I understand the limitations of the security of information transmitted. *

Patient Signature * 

Today’s Date *