Electronic Communication Consent Form

Electronic Communication Consent Form
I consent that Healing on Manes, Inc can provide their services and communicate with me via mobile phone, messages, e-mail and any kind of online communications, provided that these comminications comply with privacy regulations.

Appointment Reminders, Reschedules and Cancellations

I understand that Healing on Manes, Inc can reach me any time to remind me of my appointments or let me know in case of any change about my appointments. And I also understand that Healing on Manes, Inc can employ and use a third-party automated system to reach out me for the purpose of "confirm", "reschedule" or "cancel".

Google Calendar

I understand that Healing on Manes, Inc may utilize google calendar and I consent to the google calendar invite being shared with my email that I have provided the company.

Contact Information Change

I accept that I am responsible of notifying Healing on Manes, Inc when my contact informations change.

Consent Cancellations

I know that I can revoke this consent at any time by contacting the Company.
I consent to the use of mobile phone communications.

YesNo
I consent to the use of texting (messages) communications.

YesNo
I consent to receive electronic notifications for confirming, rescheduling or cancelling my appointments.

YesNo
I sign this consent form on the behalf of

MyselfMy childSomeone as a legal guardian
Your Name

First NameLast Name
What is your relationship with this person?
Date of Sign

MonthDayYear
Date
Signature

Clear
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