Last Updated: 2025-12-01
This Submission Consent & Communications Authorization (“Authorization”) explains what you are agreeing to when you submit information to [ LEGAL BUSINESS NAME ] (“we,” “us,” “our”) through our website, scheduling tools, chat tools, intake forms, email, telephone, or any other online or digital submission method (collectively, “Submissions”).
This Authorization should be read together with our Privacy Policy, Cookie Policy (Tracking Technologies Notice), SMS/Text Messaging Terms, Call Recording & Monitoring Notice, Medical Information Disclaimer, and Terms & Conditions (linked in the Site footer).
1) Consent to Contact You
By submitting your contact information (including your phone number and/or email address), you authorize [ LEGAL BUSINESS NAME ] to contact you at the information you provide for purposes including:
- responding to your inquiry,
- scheduling, confirming, and reminding you about appointments,
- sending administrative or service-related messages,
- providing information you request,
- sending marketing or promotional communications (where you have provided the appropriate consent).
Communications may be made via phone call, SMS/text message, email, voicemail, prerecorded/artificial voice messages where permitted, and other communication methods you provide.
2) SMS/Text Messaging Consent and Opt-Out
If you provide a mobile phone number, you acknowledge and agree that we may send you text messages in accordance with our SMS/Text Messaging Terms.
- Message frequency varies.
- Message and data rates may apply.
- You may opt out of marketing text messages at any time by replying STOP.
- For help, reply HELP.
For full details, see our SMS/Text Messaging Terms (linked in the Site footer).
3) Marketing Communications and Consent Not Required for Purchase
Where marketing communications are involved, you understand and agree that:
- your consent to receive marketing messages is not a condition of purchase, and
- you may opt out of marketing communications at any time using the unsubscribe mechanism provided (for email) or by replying STOP (for SMS), or by contacting us.
4) Accuracy of Information You Provide
You agree to provide accurate, current, and complete information. You agree not to submit information that you do not have the right to provide (including someone else’s contact information without permission).
5) Do Not Submit Sensitive Information Through Webforms
To protect your privacy, you should not submit highly sensitive personal or medical information through general website forms, chat tools, SMS, or email. If you need to discuss sensitive issues, request a secure or appropriate method of communication.
6) Not for Emergencies
Our website forms, chat tools, SMS, and email are not monitored for emergency communications. If you believe you may have a medical emergency, call 911 immediately or go to the nearest emergency room.
7) No Provider-Patient Relationship Created by Submission
Submitting information through this website, requesting information, requesting an appointment, or communicating with us through marketing channels does not create a provider-patient relationship. A provider-patient relationship (if any) is established only through appropriate clinical intake and acceptance by a licensed clinician.
8) Call Recording and Monitoring
Telephone calls may be recorded and/or monitored for quality, training, compliance, and attribution purposes, to the fullest extent permitted by applicable law. See our Call Recording & Monitoring Notice (linked in the Site footer).
9) Privacy and Data Use
Information you submit may be collected, used, and shared as described in our Privacy Policy and Cookie Policy (linked in the Site footer). We may use vendors and service providers to support communications, scheduling, analytics, and marketing.
10) Consent to Electronic Communications
You consent to receive communications from us electronically (including via email, SMS, and website notices). You agree that electronic communications satisfy any legal requirement that such communications be in writing.
11) Changes to This Authorization
We may update this Authorization from time to time. Updates are effective when posted on the website with a revised “Last Updated” date. Your continued use of the website and submission of information after updates are posted constitutes acceptance of the updated Authorization.
12) Contact
Questions about this Submission Consent & Communications Authorization may be directed to:
Name : [ LEGAL BUSINESS NAME ]
Address : [ PRIMARY BUSINESS ADDRESS ]
Email : [ PUBLIC FACING EMAIL ]
