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All TeleHealth submission forms will be sent to EcoHealth Pro-IV via electronic communication. I understand that electronic communication is a convenience and not appropriate for emergencies or time-sensitive issues. Additionally, I understand that the security and privacy of electronic communication cannot be guaranteed. Further, I understand that electronic communication should not be used to transmit highly sensitive or personal information.

With regard to my protected health information, I understand that EcoHealth Pro-IV can send unencrypted emails ONLY if I am advised of the risks. I understand EcoHealth Pro-IV and GoMD are not responsible for information lost due to technical failures.

I understand that all of the information contained in and or attached to electronic messages is privileged and confidential and is covered by the Electronic Communications Privacy Act, 18 U.S.C. § 2510-2521.

I consent to e-mail and SMS communication with EcoHealth Pro-IV and GoMD a Division of Eco Tech Living, LLC.

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