Pigeon Health is a doctor-to-patient communication tool utilized by this office to make it easier  for patients to connect directly with their health care providers. The use of this service is  completely optional. Please review the following policies, risks, and other information in order  to decide whether you wish to utilize this communication tool.

Pigeon Consent Form
Full Name

This office uses text messaging to communicate with patients regarding scheduling and to allow communication with nurses and doctors. These messages could contain personal health information (PHI) and other confidential information. While any electronic communication can be intercepted, text messages (SMS) are not encrypted, and thus information is easier to obtain if these messages are intercepted.

To mitigate the risk of accidental release of PHI or interception of PHI by a third party, you have the option not to participate in the text message communication service. By choosing to participate in the text message communication service, you are acknowledging and assuming the increased risk of interception or release of PHI.

In order to comply with HIPAA (Health Insurance Portability and Accountability Act of 1996) regulations, we ask that our clients review and sign this Communication Consent Form.
Please INITIAL to confirm that you understand and agree to each of the following statements: