[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-279878-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-279878-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","communication-consent-email-or-text-appointment-reminders","Communication Consent - Email or Text Appointment Reminders","","Health Associates offers optional email and text messaging for appointment reminders and other healthcare communications, including automated notices such as weather updates or general health information provided by a therapist. Personal phone numbers and email addresses are not shared with third parties without consent. The consent form collects patient or guardian details, authorizes message delivery, and clarifies that standard messaging rates may apply. It also provides a revocation section and states that refusing communications may affect reminder delivery and late cancellation/no-show enforcement.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/communication-consent-email-or-text-appointment-reminders/279878/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/communication-consent-email-or-text-appointment-reminders/279878.png","ImageObject",442,249,{"name":42,"@type":43},"Gloria","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What communications does the consent authorize from Health Associates?","Question",{"text":63,"@type":64},"The consent authorizes receiving email and/or text messages for appointment reminders and related healthcare communications, which may include automated notices such as weather-related updates or general health information provided by the therapist.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Is my phone number or email address shared with third parties?",{"text":68,"@type":64},"Phone and email addresses provided are not shared with any third party without the client’s consent.",{"name":70,"@type":61,"acceptedAnswer":71},"How can I revoke permission to receive reminders?",{"text":72,"@type":64},"The form includes a revocation section where the client initialing and signing can cancel future communications via email and/or text. After revocation, appointment reminders will not be received, and the late cancellation/no-show policy may still apply, including a $55 missed appointment/late cancellation fee under stated conditions.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},279878,1791454516,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":4},2336474459895,"https://ap-avatar.wpscdn.com/avatar/22000baeef7a5ed0655?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786071322749376916","Consent to Email or Text Appointment Reminders and Other Healthcare Communications  \nAs a courtesy to our clients, Health Associates offers email and/or text messaging services, including automated appointment reminders. This may also include weather-related notices or general health information provided by your therapist. Phone and email addresses provided will not be shared with any third party without your consent.  \n  (Client initials) I consent to receive text and/or email messages from the practice at my cell phone or email address and any number forwarded or transferred to that number or email address to receive communication as stated above. I understand that this request to receive emails and text messages will apply to all future appointment reminders/feedback/health information unless I request a change in writing (see revocation section below) .  \nThe cell phone number I authorize to receive text messages for appointment reminders/feedback/general health information is (include area code) is: ( )  —  .  \nThe email address I authorize to receive email messages for appointment reminders/feedback/general health information is:    \nHealth Associates does not charge for this service, but standard text messaging rates may apply per your wireless plan (contact your carrier for details) .  \nPatient Name (Print Clearly):   Patient/Guardian Signature:   Date    \nYou have the right to refuse text and email reminders from Health Associates at any time by initialing and signing below.  \n  (Client initials) I hereby revoke my permission for future communications via email and/or text. I understand that I will not receive reminders for my appointments at Health Associates and have read and understand the late cancelation/no show policy which states I may be assessed a $55 missed appointment/late cancelation fee if I cancel less than 24 hrs before my appointment or do not show for my scheduled appointment.  \n  I revoke my permission to receive text messages.  \n  I revoke my permission to receive email messages.  \nPatient Name (Print):   Patient/Guardian Signature:   Date:","cbCait9WEAgtFQzA","https://ap.wps.com/l/cbCait9WEAgtFQzA","pdf",36025,"English","# Consent to communications\n## Appointment reminders and healthcare notices\n## Privacy and non-sharing of contact information\n## Revoking permission and reminder impact","[{\"question\":\"What communications does the consent authorize from Health Associates?\",\"answer\":\"The consent authorizes receiving email and/or text messages for appointment reminders and related healthcare communications, which may include automated notices such as weather-related updates or general health information provided by the therapist.\"},{\"question\":\"Is my phone number or email address shared with third parties?\",\"answer\":\"Phone and email addresses provided are not shared with any third party without the client’s consent.\"},{\"question\":\"How can I revoke permission to receive reminders?\",\"answer\":\"The form includes a revocation section where the client initialing and signing can cancel future communications via email and/or text. After revocation, appointment reminders will not be received, and the late cancellation/no-show policy may still apply, including a $55 missed appointment/late cancellation fee under stated conditions.\"}]","Communication Consent - Email or Text Appointment Reminders | PDF",1789528967]