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Consent To Use Electronic Communications

This Consent to Use Electronic Communications form outlines the ways in which a medical clinic is permitted to use a patient’s information in a comprehensive appendix. Medical clinics can use this form to collect their patient’s consent to use electronic communications from the physician or staff via email, text messaging, video conferencing, or a web portal. In addition to four boxes patients are asked to check, it also collects basic patient contact information and their signature.