Patient Portal: The patient portal is an optional service that allows parents/guardians to retrieve selected patient information and communicate directly with our staff. If you are interested in adding this feature for your family, please read the following information and sign this form, giving us consent to activate a portal for you.
Text Appointment Reminders: This is an automated text reminder of your child’s appointment 1-3 days in advance. This feature would replace the reminder calls you now receive. We require one cell phone number on file to enable this feature.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
I understand that this authorization for disclosure is in effect until I choose to have it revoked, and I may do so at any time.
Your information will be encrypted.