Patient Consent for Communication
via Unsecure Platforms

Purpose: I authorize communication with my healthcare provider using unsecure platforms such as WhatsApp, FaceTime, SMS, or unencrypted email. I understand these platforms may not meet HIPAA security standards.

Risks: I understand that unsecure communication may increase the risk of unauthorized access to my health information.

Consent: I voluntarily consent to receive communication via unsecure platforms & I understand may revoke this consent at any time by notifying my provider in writing.