Electronic Communication Consent Form

The purpose of this form is to obtain your consent to allow DMV Medical Group to communicate with you via email, phone, voicemail, and text message (SMS). This form also provides important information about the potential risks of these communication methods, the appropriate uses and limitations of electronic communication, and the steps DMV Medical Group takes to safeguard and handle electronic communication. By submitting this form, you acknowledge and consent to the terms outlined below.

1. Risks of Using Email, Phone, Voicemail, and Texting

While DMV Medical Group takes reasonable steps to maintain the security and confidentiality of communications, electronic communication carries certain risks, including but not limited to:

  • Emails, phone calls, voicemails, and text messages can be accidentally forwarded, stored electronically and on paper, or misdirected to unintended recipients.

  • Messages may be intercepted, altered, or accessed without authorization.

  • Backup copies of emails and texts may still exist even after deletion.

  • Employers and online service providers may have the right to inspect emails sent through their systems.

  • Emails, phone calls, voicemails, and text messages can be used as legal evidence in court.

  • These communication methods are not guaranteed to be secure, and confidentiality could be compromised by third parties.

2. Conditions for the Use of Electronic Communication

DMV Medical Group cannot guarantee complete security, but will take reasonable precautions to protect your information. However, by consenting to electronic communication, you acknowledge and accept the following:

  • Limited Use for Healthcare Communication: Text messages and emails should not be used for urgent or sensitive health-related matters. If you have a medical emergency, call 911 or visit the nearest emergency facility.

  • HIPAA Compliance: We adhere to applicable privacy and security regulations, including HIPAA, to protect patient information. However, we encourage you to avoid sharing personal medical details through text or email.

  • Liability Disclaimer: DMV Medical Group takes reasonable steps to safeguard communication. However, we are not responsible for breaches beyond our control, such as unauthorized access by third parties.

3. Consent for Communication

By signing and submitting this form, you consent to receive text message(s), emails, phone calls, and voicemail from DMV Medical Group at the contact information you provided, including messages sent by an automated system. Message frequency may vary, and standard messaging rates may apply.

If you have any questions or concerns, please contact our office directly.

Property of DMV Medical Group, LLC, 2026