• CONSENT FOR NOTICE BY ELECTRONIC TRANSMISSION

  • Improving Lives Counseling Services, Inc. is now offering the option to receive notifications and billing statements via email instead of through the U.S. Postal service.

    • To adopt email as your primary mode of notification, please complete this authorization 

     

  • After providing authorization for electronic communication you can change or revoke your designation at any time by witing or emailing Improving Lives Counseling Services.

    Improving Lives Counseling Services

    6216 South Lewis Avenue Suite 102

    Tulsa, Oklahoma 74136

    Becca@ImprovingLivesCounseling.com

  • I hereby authorize Improving Lives Counseling Services (ILCS) to send all notifications and statements via email instead of through the U.S. Postal service. I understand that these emails may contain personal information such as names, addresses, and services received from ILCS. I also understand that these communications may not be secure. I agree that it will be my responsibility to notify ILCS of any changes to my email address listed below.

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  • Please initial one of the following options and sign the bottom of the form.

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