Continuing Hope Counseling LLC 10th 534P.O. Box 73536Fairbanks, Alaska 99707 Ave Fax (907) 451-8207 Phone (907) 451-8208
Consent and Risk Disclosure for Text Message Notification
As part of the appointment logistics for your provider, Continuing Hope Counseling (CHC) asks that you inform your provider of your arrival at your appointments by sending a text message to their business number at (907) 415-4727. By using this method, you acknowledge and consent to the following:
CONSENT TO USE TEXT MESSAGING - I understand that by sending a text message, I am notifying the provider of my arrival at the appointment. I am providing consent for the provider to receive and review my text messages related to appointment arrivals.
LIMITED USE OF PHONE NUMBER- I understand that the phone number provided is to be used only for notifying the therapist of my arrival and is not to be used for other types of communication, including therapy-related questions, scheduling changes, or personal discussions. If I must engage in other types of communication, I will contact CHC or speak with my provider via telephone or in person. I understand that the phone number provided is not to be used for emergency situations. If a true emergency arises, I will contact 911 or present at the nearest emergency room or urgent care facility. I agree not to send text messages for any purpose other than notifying the therapist of my arrival for appointments.
MONITORING HOURS -I understand that the phone number provided is only monitored during the provider's business hours. Text messages sent outside of these hours may not be seen until the next business day. I understand that messages sent outside of business hours will not be acknowledged until the provider is next available during business hours.
POTENTIAL RISKS -Text messages are not a completely secure form of communication. The provider will take appropriate steps to maintain confidentiality; however, by agreeing to text message communication, I acknowledge the inherent limitations in confidentiality when using this method. I understand there is a small risk of unauthorized access to the information contained in text messages. I understand that text messages may not be immediately received if there are issues with the phone network or system errors, potentially delaying acknowledgment of my arrival.
VOLUNTARY PARTICIPATION -I understand that using text messages for arrival notification is optional. I can discuss with my provider and/or CHC and choose an alternative method of communication to inform the therapist of my arrival.
By signing below, I confirm that I have read, understand, and consent to the use of text messages for notifying my provider of my arrival. I acknowledge the potential risks involved and agree to hold CHC and my provider harmless for any issues arising from the use of this communication method.