Informed Consent for Text Messaging
* Signable version will be sent to potential clients through our portal after you make an appointment. *
With your consent, Hope in Healing Therapy Inc. would like to send text (SMS, RMS) messages to the mobile number you have provided in our records.
By providing your informed consent where indicated, you acknowledge that you have understood the information below and agree to participate in our text (SMS, RMS) messaging service.
Purpose and Description: Hope in Healing Therapy Inc.’s text (SMS, RMS) messaging service is designed to provide you with helpful information, appointment reminders, provide last minute cancellations, allows you to reach out in an non emergency crisis situation and notifications via text messages sent to your mobile phone. We may use text (SMS, RMS) messages to communicate with you for a variety of purposes, including:
Confirmation of appointment date and times
Communication between you and therapist if you a running a few minutes late
Last minute cancellations by you or the therapist.
Request last minute non emergency crisis appointments
Or receive last minute non emergency crisis help.
Voluntary Participation: Participation in our text (SMS, RMS) messaging service is entirely voluntary. After you sign this form; the first text you will receive will state:
-"Hi this is ____ from Hope in Healing Therapy Inc. in order to Opt-In to receive future text messages regarding appointment reminders, cancellations, or urgent communication regarding your session please respond by texting "START."
- You have the right to refuse or withdraw your consent at any time.You can also opt out by text at any time by texting “STOP” or emailing admin@hopeinhealingtherapy.org.
Benefits and Risks: Benefits: The text (SMS, RMS) messaging service aims to keep you informed about Hope in Healing Therapy Inc. by providing an additional method of convenient and timely communication.
Risks: While every effort will be made to protect the security and confidentiality of information transmitted through text (SMS, RMS) messages, there are inherent risks associated with all electronic communication. These risks include unauthorized access, loss of privacy, and potential breach of sensitive information. It is important to be aware that text (SMS, RMS) messages may not be entirely secure and could be intercepted or accessed by unintended recipients.
Potential Costs: Participation in the text (SMS, RMS) messaging service may involve standard text messaging charges applied by your mobile service provider. Please consult your mobile service provider regarding any applicable fees or charges.
To opt in and provide consent to our text messaging communication please sign below stating you understand the risks and benefits.
Client’s Signature:_______________________________________________________
Date:_____________________