orlandoresortschiro.com - Consent To Treat

PATIENT CONSENT FOR COMMUNICATION:
We have the ability to call or text you, reminding you of your appointments. If you would like to receive this feature in the future, please read the consent below and sign. Patients in our office may be contacted via phone/text messages to be reminded of an appointment, to obtain feedback on an experience within our office, and to provide general health reminders/information.

I consent to receiving appointment reminders and other healthcare communications via telephone from ORLANDO RESORTS SPINE AND BODY (initial)
I consent to receive text messages from Type a label at my cell phone and any number forwarded or transferred to that number. The cell phone number that I authorize to receive text messages for appointment reminders, feedback and general health reminders/information is: Area Code Phone Number , Carrier: Type a label. (initial)
I consent to emails, to receive communications as stated above. The email that I authorize to receive email messages for general health reminders/feedback/information is: Type a label. (initial)

I understand that this request to receive emails and/or text messages will apply to all future appointment reminders/feedback/health information unless I request a change in writing. (initial)

Signature:

Date:

Date

PATIENT CONSENT TO TREAT:

I hereby authorize the Doctor’s/Nurse Practitioners’ of ORLANDO RESORTS SPINE AND BODY to treat my case as they deem appropriate through the use of lab testing, traction, durable medical equipment, rehabilitation, manual therapy, chiropractic manipulation of the spine, nutritional support, and diagnostic testing. I realize the goal of holistic health care is to strengthen the patient's body in order to heal themselves. It is understood and agreed the amount paid the clinic for x-rays is for interpretation and only the x-ray negatives will remain the property of this office, being on file. The patient also agrees that he/she is responsible for all bills incurred at this office.

Signature:

Date:

Date