INFORMED CONSENT FOR TEXT AND EMAIL COMMUNICATION

I give Kassidy Wren, RDN, LDN permission to communicate with me via text and email as part of nutrition counseling and/or weight loss services. Kassidy Wren, RDN, LDN will communicate information by text or email with regards to the following topics - appointment scheduling/cancellation, sending/receiving meal plans or educational materials, progress reports for weight-loss, referral information, receipts for services rendered, client food preferences information, General health information, daily accountability throughout weight-loss program, and generic health questions or concerns as it pertains to a previous nutrition consult appointment.

Risks of using text/email:

Transmitting personal health information via electronic mail or text poses several risks of which the patient should be aware. The risks include, but are not limited to, the following:

- The privacy and security of text and email communication cannot be guaranteed. Employers and online services have a legal right to inspect and keep emails that pass through their system. It is impossible to verify the identity of the sender, or to ensure that only the recipient can read the email.

- Emails can introduce potentially damaging viruses into a computer system.

- It is possible for email to be forwarded, intercepted, circulated, stored and altered without the knowledge or permission of either the sender and/or the recipient. Email senders can easily misaddress an email, resulting in the sending of information to unintended and unknown recipients.

- It is possible for a text to be sent to the wrong phone number.

- Text and email are indelible. Even after the sender and recipient have deleted their copies of the email, back-up copies may exist on a computer or in cyberspace.

- Use of text or email to discuss sensitive information can increase the risk of such information being disclosed to third parties.

- Text and email can be used as evidence in court.

Conditions of using text/email:

Reasonable means will be used to protect the security and confidentiality of text and email information sent and received. However, because of the risks outlined above, guarantee of the security and confidentiality of text and email communication cannot be made, and Kassidy Wren, RDN, LDN along with Strength and Dignity Dietetics, LLC will not be liable for improper disclosure of confidential information that is not the direct result of intentional misconduct by Kassidy Wren, RDN, LDN. Thus, the client must consent to the use of text and email for patient information.

Consent to the use of email includes agreement with the following conditions:

- Texts and emails to or from the client concerning diagnosis or treatment may be printed in full.

- Although the intention is to promptly respond to all texts and emails, there is not a guarantee that any particular text or email will be read and responded to within any particular period of time. Thus, the client should not use text or email for medical or psychological emergencies or other time-sensitive matters.

- Text and email communication is not an appropriate substitute for one-to-one appointments. The client is responsible for following up on recommendations and for scheduling appointments where warranted.

- If the client’s text or email requires or invites a response from Kassidy Wren, RDN, LDN and the client has not received a response within a reasonable time period it is the client’s responsibility to follow up to determine whether the intended recipient received the text or email and when the recipient will respond.

- Kassidy Wren, RDN, LDN is not responsible for information loss due to technical failures.

Instructions for communication by text/email To communicate by text or email, the client shall:

- Limit or avoid using an employer’s computer. Inform Kassidy Wren, RDN, LDN of any changes in client email address or cell phone number.

- Take precautions to preserve the confidentiality of texts and emails, such as using screen savers, lock screens, and safeguarding computer and phone passwords.

- Withdraw consent by email or written communication to Kassidy Wren, RDN, LDN.

- Should the client require immediate assistance, or if the client’s condition appears serious or rapidly worsens, the client should not rely on text or email. Rather, the client should call a medical professional, mental health provider or travel to the nearest emergency department (client will decide on best choice depending on the nature of the emergency).

Client acknowledgement and agreement:

By checking the consent box and signing below, I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communication of text and email between Kassidy Wren, RDN, LDN and me, and consent to the conditions outline herein, as well as any other instructions that Kassidy Wren, RDN, LDN may impose to communicate with clients by text or email. I acknowledge the right of Kassidy Wren, RDN, LDN to, upon the provision of written notice, withdraw the option of communicating through text or email. Kassidy Wren, RDN, LDN answered any questions I may have had.
Consent(Required)
Enter (First and Last Name)(Required)
Email(Required)
MM slash DD slash YYYY

THIS SITE IS PROTECTED WITH RECAPTCHA, PRIVACY POLICY, TERMS OF USE, AND DISCLAIMER APPLY.

0
    0
    Your Cart
    Your cart is emptyReturn to Shop