Consultants in Plastic Surgery
P. A
7700 San Felipe, Suite #275
Patient Consent for Use of Email Communications
To better serve our patients, this office has established an email address for some forms of
communication. For routine matters that do not require immediate response, please feel free to
contact us at
Please remember however, that this form of
communication is not appropriate for use in an emergency. The turnaround time for routine
patient communication is 24 hours. The service provider may delay message delivery.
you require urgent or immediate attention, this medium is not appropriate.
When sending an email, please put the subject of your message in the subject line so we can
process it more efficiently. Also, be sure to put your name and return telephone number in the
body of the message. We also ask that you acknowledge receipt of emails coming from this office
by using the auto reply feature.
Communications relating to diagnosis & treatment will be filed in your medical record.
This office is dedicated to keeping your medical record information confidential. Despite our best
efforts, due to nature of email, third parties may have access to messages.
When communicating
from work, you should be aware that some companies consider email corporate property and
your messages may be monitored. Even when emailing from home, you may feel that access to
our email is not controlled, so you should take that into consideration. In addition, you should be
aware that, although addressed to me, my staff, and/or colleagues would have access to this
I understand that this office will not be responsible for information loss or delay or breaches in
confidentiality that are due to technical factors beyond this office’s control.
I understand and agree to the above email policy.
By signing below, you are agreeing that we may send medical related correspondence to you via
email, and that we may respond to your emails to us via email.
Patient Signature
Witness (Optional)