CONSENT  FOR  LIMITED COMMUNICATIONS:  Email, Text Message, Voice Message

 

By requesting and/or agreeing to receive or send text, email, or voice message correspondence to Dr. Title, M.D., you are agreeing to the use of electronic media for transmission of information.

 

By checking the box, you hereby expressly agree and understand that:

 

• You request and would like to receive appointment reminders by both Email and Text.If you would prefer NOT to receive Email or Text reminders then you will need to make your appointment by telephone at (212) 581-9532 or (718) 358-3310.

• No assurances or guarantees have been made that any Text, Email or Voice messages will remain confidential.

• Text and/or Email messages may be viewed by designated members of Dr. Title’s office staff who require it to perform their specific job function.

• Text, Email or Voice Message information sent or received at either your home or place of employment can be accessed by third parties.

• Dr. Title may not always be available to answer Texts, Emails or Voice Messages. Messages that you send may not receive a response for several hours or even several days.Except for rare occasions, no response will be made after office hours, or at any time on weekends or holidays..

• Dr. Title will not answer complex questions received by Text, Email, or Voice message.Instead, you will need totelephone Dr. Title with such questions.

• The use of Text and/or Email is restricted to certain types of confidential medical information.Information which will not be related by Email include, but is not limited to:requests for record release.Information of this nature will only be related by telephone, letter, fax, or in person.

• You must include in all Text and/or Email communications: the type of correspondence, name of provider, your first and last name, phone number, and date of birth.

• Printed copies of Text and/or Emails sent by you and/or sent to you regarding care and treatment will become a part of your patient’s medical record.

• We may contact you by Email and/or Text in the future to tell you about specials, new products, or other services.

 

By completing an online appointment request and checking the box confirming you have read the above, you expressly agree that you have read and understand everything in this Consent for Limited communications and agree to receive Email and/or Text communications from our office including appointment reminders and marketing communications.

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If you do not want to receive any appointment reminders or marketing communications by Email or text, then please call our office directly to request an appointment date.

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