• Lookout Mountain CSB

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  • Consent For Contact

  • Contact Preference

  • There may be times when we need to contact you regarding your services here at our
    agency. As a precaution to protect your privacy, we would like to know the best method
    for communicating with you.

  • I understand that text messaging and email are not secure means of communication and may compromise my confidentiality. Text messaging rates may apply. I understand that it is the Agency's policy to utilize these methods of communication at a minimum such as appointment reminders.

    I understand that land lines and cell phone communication may not be completely secure and confidential. There is a possibility that someone could overhear or intercept my conversations.

  • Contact Information

  • CONSENT

  • By signing this document, I am giving permission to be contacted by the method(s) indicated above. I have the right to change the preferred method of contact and may do so by informing a clerical support staff worker at this agency. I am responsible for keeping the agency updated with current contact information.

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