Consent for Communication:
I, the undersigned patient, hereby consent to receive communications from Vital Total Health Medical Group, Inc via the following methods:
I understand that while Vital Total Health Medical Group Inc will take reasonable steps to protect the confidentiality of the communications and protect your data with secure storage to prevent unauthorized access, I acknowledge that electronic communication is not completely secure and may be at risk for unauthorized access.
These terms and conditions I can find by visiting https://form.jotform.com/242244827825057
Waiver of HIPAA Protections:
I understand that by agreeing to communicate via email and text message, I am waiving certain protections provided under the Health Insurance Portability and Accountability Act (HIPAA). I understand that this means that my health information may not be as protected during these forms of communication. For more information review our Privacy Policy at https://vitaltotalhealth.com/privacy
Patient Responsibilities:
I agree to inform Vital Total Health Medical Group, Inc of any changes to my email address or phone number. I understand that it is my responsibility to keep my personal communication devices secure and to be vigilant about the privacy of my information.
Acknowledgment and Signature:
Do you Agree to receive text messages and emails from Vital Total Health Medical Group Inc sent from 925-388-9800? Message frequency varies and may include medical care information and appointment reminders and order information. Message and data rates may apply. Reply STOP at any time to end or unsubscribe, or email info@vitaltotalhealth.com . For assistance, reply HELP or contact support at 925-388-9800. You will receive a final SMS text message confirming the removal of your permission to communicate by email or text.