EMAIL/TEXT/PORTAL COMMUNICATION CONSENT

I. Available Communication Methods

This practice offers three methods of communication:

• Client Portals - These are the most secure method of communication and are strongly recommended for any exchange involving personal health information. All of your providers will use the client portals.

  • Jane App is secure, HIPAA-compliant electronic healthcare record for scheduling, billing documents, and clinical forms. https://emilywoodmdphd.janeapp.com/

  • Spruce Health is a secure, HIPAA-compliant communication platform for connecting with your providers and staff. https://spruce.care/EmilyWoodMDPhD-patients

• Email - A convenient but non-secure method of communication. Standard email is not HIPAA-compliant and cannot guarantee the privacy of information exchanged. Your specific provider may or may not use email to communicate with patients.

• Text/SMS - A convenient but non-secure method of communication. Standard SMS is not HIPAA-compliant and cannot guarantee the privacy of information exchanged. Your specific provider may or may not use email to communicate with patients.

II. Important Notice Regarding Non-Secure Communication

While email and text messaging offer convenience, it is important that you understand the limitations and risks associated with their use before consenting to them as methods of communication with this practice.
Unlike the client portal, standard email and SMS are not encrypted and are not considered HIPAA-compliant channels. This means that any information exchanged through these methods could potentially be accessed by unauthorized parties. Risks include but are not limited to:

• Messages being intercepted during transmission
• Messages being accessed by others who share your device or account
• Delivery to an unintended recipient due to an error in address or number
• Unauthorized access resulting from a security breach of either party's account or device

By consenting to communication via email and/or text, you acknowledge these risks and agree to hold this practice harmless in the event of a breach of confidentiality arising from the use of these channels. This includes situations resulting from an error in your contact details, a typographical mistake in addressing, or unauthorized access to either party's account or device.
Please be aware that any communication exchanged between you and your providers — regardless of the method used — becomes part of your official clinical record.

III. Authorization To Communicate

By completing and signing this form, you are providing explicit authorization for Emily Wood, MD, PhD to correspond with you through your chosen communication method(s) regarding your care. This includes appointment scheduling, administrative matters, and where indicated, clinical communication. This authorization is required for your clinicians to initiate contact with you through email or text, and ensures that all communication is conducted with your full knowledge and agreement, in compliance with HIPAA and applicable California privacy law. Without this authorization, communication will be limited to the secure client portal only.

IV. Clinical Communication

For any communication involving personal health information, clinical questions, or sensitive matters, use of the secure client portal is strongly encouraged. While you may choose to communicate via email or text, please understand that doing so carries the risks outlined above and that the confidentiality of such exchanges cannot be guaranteed by this practice.

V. Appointment Reminders

If you are registered through the client portal, appointment reminders will be sent automatically via your preferred method as selected in your portal settings. Please ensure your contact information is kept current.

VI. Emergency Communication

Please note that none of the available communication methods are monitored in real time and are not appropriate channels for urgent or emergency communication. In the event of a crisis or emergency, please call 911.

X. Changes to this Notice

We reserve the right to revise or change provisions on this Notice. We will implement the new Notice provisions effective for all services provided and confidential information we maintain. The most current version of this notice will be available on our website at https://www.emilywoodmdphd.com/policies. The Notice will contain the effective date on the top of the first page.

Acknowledgement & Consent

By signing below, I confirm that I have read and understood this form in full. I understand the privacy limitations associated with email and text communication and voluntarily accept the risks outlined above. I acknowledge that any communication exchanged with my providers through any channel becomes part of my official clinical record. I understand that I may update my communication preferences at any time by submitting a written request.

Patient (or Legal Guardian if patient is a minor)

Signature: ___________________________________________

Date: ___________________________________________

Printed Name: ___________________________________________

Relationship (if signing on patient's behalf): ___________________________________________