Important Policy Information for Primary Care Services

Refill Policy

Testosterone Intramuscular Injectable Supplies

Testosterone Subcutaneous Injectable Supplies

Self-Injection Instructions

TEXT (SMS) MESSAGING CONSENT FORM

Innovative Primary Care offers patients the opportunity to communicate via text messaging.
These messages may contain personal health information, including appointment reminders, billing details, and pre- or post-procedure instructions. 

Risk: Text messages are not encrypted and can be intercepted by third parties or sent to wrong numbers. 
Limitations: Do not use text to communicate urgent, sensitive, or emergency information. Call 911 in an emergency.
Privacy: No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.

I understand the risks and agree to the following:

1. I authorize Innovative Primary Care to send SMS messages to my mobile phone number provided above.

2. I am responsible for providing an accurate number and notifying the practice of any changes.

3. Standard text messaging rates or cellular data fees from my carrier may apply.

4. I understand that text messages may be saved in my medical record.

5. I may revoke this consent at any time by replying "STOP" or notifying the office in writing.