LEGAL CONSENT & AUTHORIZATION FOR PERSONAL INFORMATION PROCESSING AND ELECTRONIC COMMUNICATIONS
By submitting this contact form, I voluntarily authorize Fugly Toenails™ and JAWS Podiatry to collect, store, use, and process my personal information, contact information, message content, and any health-related information I voluntarily choose to provide through this form for the limited purposes of responding to my inquiry, administrative follow-up, routing my request to the appropriate team member or service, providing general information about Fugly Toenails™ and JAWS Podiatry services, and related electronic communications.
I understand that this Contact Us form is intended for general inquiries only. I understand that submitting this form does not create a doctor-patient relationship, does not constitute a telemedicine evaluation, does not guarantee eligibility for telemedicine care, and does not provide a diagnosis, treatment recommendation, prescription decision, or prescription fulfillment.
I understand that if I want to request a Professional Virtual Evaluation, I must complete the appropriate Start Evaluation form and provide the required eligibility, location, consent, and health-related information requested in that form.
This authorization includes communications from Fugly Toenails™, JAWS Podiatry, and their authorized staff or representatives via email, phone calls, SMS text messages, WhatsApp, and other electronic or messaging communication channels, strictly for purposes related to responding to my inquiry, administrative follow-up, scheduling or routing assistance, and providing appropriate next steps.
By providing my phone number and submitting this form, I expressly consent to receive transactional and informational communications related to my inquiry, including but not limited to responses to my message, requests for additional information, service-related updates, appointment or scheduling coordination if applicable, and appropriate next steps.
Message frequency may vary. Message and data rates may apply. I understand that I may opt out of SMS or messaging communications at any time by replying STOP, and I may request assistance by replying HELP. I understand that opting out of SMS or messaging communications may affect how Fugly Toenails™ and JAWS Podiatry are able to communicate with me electronically, but I may request communication through another available channel.
I understand that any health-related information I voluntarily share through this form or through electronic communications may include Protected Health Information (PHI), and that Fugly Toenails™ and JAWS Podiatry will implement reasonable safeguards to protect my information in accordance with applicable privacy and healthcare requirements, including HIPAA where applicable.
I acknowledge that this contact form is not intended for urgent medical concerns or emergencies. If I am experiencing severe pain, drainage, spreading redness, warmth, fever, signs of an active infection, or any urgent medical concern, I understand that I should seek in-person medical care or urgent medical attention from a licensed healthcare provider.
This consent is granted in accordance with applicable privacy, healthcare, telehealth, and electronic communications laws and regulations, including, where applicable, HIPAA, the Florida Telehealth Act, the Telephone Consumer Protection Act (TCPA), the CAN-SPAM Act, and other applicable federal, state, and data protection requirements.
For more information, please review our Privacy Policy and Terms & Conditions at fuglytoenails.com.