Consent to Receive Electronic Lab Results

Consent to Receive Electronic Lab Results

Purpose of Consent
I understand that I have the option to receive my lab results via email and/or SMS text message. I also understand that these methods of communication may not be as secure as other methods, and there is a slight risk of my protected health information (PHI) being accessed or disclosed by a third party. By signing/initializing this form, I consent to receiving my lab results via email or SMS to the email address or mobile phone number provided, and that standard text messaging rates may apply.

Patient Full Name
Patient Full Name
First & Middle Name
Last Name