I agree to allow Glow Family Dental to contact me in the following methods regarding my private health information, evaluation, and treatment. I authorize Glow Family Dental to leave messages for me when I am unavailable. I understand that messages may contain confidential information.
When we email you with any protected health information. You will be asked to enter a code before you can view the email. The code will be the last four digits of your primary phone number.
I understand that I may revoke this consent at any time by so advising Glow Family Dental in writing. Mybrevocation of consent will not affect my ability to obtain future health care nor will it cause the loss of any benefits to which I am otherwise entitled.