Email Communication Agreement
I authorize Vivid Orthodontics to communicate via email, without prior notice, relating to my treatment, health, or payment by email or other electronic means, without encryption or special security precautions, to me or someone I designate, or to other healthcare providers, health plans and others involved in my treatment, payment for my treatment, or Vivid Orthodontics health care operations. The patient information that may be emailed may include my x-rays, health history, diagnosis, treatment, and payment records. I understand that my Protected Health Information may be contained in these emails.
I am aware that there is some level of risk that third parties might be able to read unencrypted emails.
I am responsible for providing the dental practice any updates to my email address.
I can withdraw my consent to electronic communications by calling:(920) 739-2400 or in writing at any time, but if I do so, this will not affect emails that Vivid Orthodontics already sent before receiving my instructions to stop.