Purpose: To obtain your consent to receive communications by email and text message.
By checking the consent box and submitting your information, you agree that Omni may contact you via email and SMS for: – Care‑related communications: appointment confirmations, reminders, follow‑ups, lab/imaging instructions, and other non‑urgent messages related to your care. – Non‑care / marketing communications (optional): health tips, clinic news, promotions, vaccine/clinic campaigns.
Frequency: Varies by care needs and preferences.
Opt‑Out: Email: use the unsubscribe link. SMS: reply STOP to end, HELP for help.
Security: Email and standard SMS may not be encrypted. Do not include sensitive or urgent information. For urgent matters call (301) 350‑8500 or 911 for emergencies.
Consent Not Required: Your consent to marketing communications is not a condition of receiving care or services. You can receive clinical care even if you do not opt in to marketing communications.
Contact Info: You confirm the contact information you provide is your own and accurate; you will notify us of changes.
Short General Consent to Treat (Web Version)
By checking the consent box, I request and authorize Omni clinicians to provide evaluation and treatment as deemed necessary and appropriate, including routine diagnostic tests and procedures. I understand I may withdraw consent at any time and that I can ask questions about my care. I understand this is not an emergency service and that for emergencies I will call 911.
Telehealth Consent (Brief)
Scope: Telehealth uses electronic communications to enable clinical services at a distance.
What to expect: – Benefits include convenience and improved access to care. Risks include technical failures, limited exam, or privacy concerns if you choose an insecure location/device. – We will verify your identity and location at each telehealth visit. If we suspect an emergency, we may contact local services.
Your responsibilities: – Ensure you are in Maryland (or an authorized state) at time of visit, and in a private, safe location. – Do not record the session without consent. – Provide a phone number for backup contact.
Privacy: Telehealth visits are documented in your medical record and protected under HIPAA and applicable law.
Consent: By checking the telehealth consent box, you consent to receive services via telehealth and understand you may withdraw consent at any time by notifying us.