You may give permission to Orangewood Foundation employees to communicate with you by phone, text message (SMS or MMS), and video conference. This form provides information about the risks of these forms of communication, guidelines for phone, text, and video conference communication, and how we use phone, text, and video conference communication. This form will also be used to document your consent for communication with you by phone, text message (SMS or MMS), and video conference.
1. Risks of using phone and/or texting: The transmission of information by phone and/or texting has a number of risks that clients should consider prior to use. These include, but are not limited to, the following risks:
2. Conditions for the use of phone, voicemail, and text: Orangewood Foundation and their employees cannot guarantee but will use reasonable means to maintain the security and confidentiality of phone, voicemail, and text information sent and received. Orangewood Foundation and their employees are not liable for improper disclosure of confidential information that is not caused by the Orangewood Foundation and their employees’ intentional misconduct.
Clients/Parents/Legal Guardians must acknowledge and consent to the following conditions:
Orangewood Foundation may also use a specialized video-conferencing services, Doxy.me (which is HIPPA and HITECH protected) or Zoom (NOT HIPPA or HITECH protected), for video and audio conferencing and chat. There is always a risk when using internet-based communication, as it cannot guarantee 100% security and confidentiality.
In the event of an emergency, call 911 or go to the nearest emergency room.
Client Acknowledgement and Agreement
I acknowledge that I have read and fully understand this consent form. I understand that I have the option to choose various methods of communications. I understand the risks associated with transmission of information by phone, text, and video conference between Orangewood Foundation employees and me. I understand that standard text messaging rates may apply to any messages received, and I agree not to hold the Orangewood Foundation liable for any electronic messaging charges or fees generated by this service. I also understand that Orangewood Foundation or I may revoke this permission in writing at any time. I consent to the conditions and instructions outlined in this form.