Patient Forms
HIPAA Notice (Privacy Policy)
Consent to Treat (Medicare)
Text Message Disclosure
The practice will request written confirmation of opt-in for on-going text messaging and text messages initiated by the practice. Initial opt-in for text messaging from Achieve More Sports and Wellness may also occur by written or verbal request for a one-time text message response for specific information to be sent via text message.
1. Message and data rates may apply
2. Test message communications may be unsecured. A risk of unsecured text messages is the potential that the communication could be read by a third party.
3. Sending “STOP“ to opt-out of future messaging. Reply HELP for more information.
4. Full Privacy Policy is provided in the patient forms above.
5. Privacy: Protected Health Information (PHI) including Personally Identifiable Information (PII) can only be shared based on the limitations set forth within the Health Insurance Portability and Accountability (HIPPA) Act and detailed in the HIPPA Privacy policy linked above. No protected information, HPI or PII, can ever be sold to third parties.
6. Written consent for on-going text messaging is obtained as part of HIPPA acknowledgement and/or by completion of the text messaging consent form, linked below.