Online Class Consent

As a prior patient of Pregnant Choices Medical Clinic, you have requested to continue a non-medical relationship to receive educational classes. These classes are not to replace OB care or act as medical advice. All communication for the classes will be through call, email, text messaging or ZOOM. This fact sheet will inform you about the risks of communicating via email, text messaging and ZOOM.
Email/text/ZOOM communications are two-way communications. However, responses and replies to email/text messages/ZOOM sent to or received by either you or Pregnant Choices Medical Clinic may be hours or days apart. This means that there could be a delay in receiving results or answers to questions that you may have regarding your condition. Therefore, if you have an urgent need or an emergency, DO NOT contact us via email/text/ZOOM, CALL 911.
Although all information through email/text/ZOOM to Pregnant Choices Medical Clinic will be kept confidential, email/text messages on your computer, your laptop, ZOOM Messaging and/or your phone have inherent privacy risks especially when your email access or cell phone is provided through your employer or when access to your email/text messages are not password protected. Unencrypted email messages provide as much privacy as a postcard. You should not communicate any information with Pregnant Choices Medical Clinic that you would not want to be included on a postcard that is sent through the Post Office. This applies for the ZOOM Video Chat as well.
Email/text messages may be inadvertently missed. To minimize risk, Pregnant Choices Medical Clinic requires you respond appropriately to a test email/text message before we allow health information about you to be communicated via email/text messaging/ZOOM. You can also help minimize this risk by using only the email/text address that you provided to us to communicate with Pregnant Choices Medical Clinic. Email/text messages are sent at the touch of a button. Once sent, an email/text messages cannot be recalled or cancelled. Errors in transmission, regardless of the sender’s caution, can occur. Neither you nor the person reading your email/text messages can see the facial expressions, gestures, or hear the voice of the sender. Email/text messages can be misinterpreted. If you choose to communicate with us using ZOOM during the COVID-19 outbreak, please be aware this is not a secure line of communication. While we will keep your conversation confidential, this program is not HIPAA compliant.
It is the policy of Pregnant Choice Medical Clinic that your email/text messages and all responses to them become part of your medical record.
I understand and agree to the following
· I certify the email address/cell phone number provided on this request is accurate and I accept full responsibility for messages sent to and from this address
· I have read and understand the important information above.
· I agree to hold Pregnant Choices Medical Clinic and its individual associates harmless from all claims and liabilities arising from or related to this request to communicate via email/text messages/ZOOM.
· By replying YES to this consent, I give my permission for Pregnant Choices to communicate as indicated in the information above.