Strash Foot & Ankle Care | Email Consent Form
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Email Consent Form

• Strash Foot & Ankle Care cannot guarantee the security and confidentiality of an e-mail
transmission. Employers and on-line services have the right to access and archive e-mail transmitted
through their systems. If your e-mail is a family address, other family members may see your messages.
therefore, please be aware that you e-mail at your own risk. Because of the many interne and
e-mail factors beyond our control, we cannot be responsible for misaddressed, misdelivered or interrupted
e-mail. Your health care provider is not liable for breaches of confidentiality caused by yourself
or a third party.
• E-mail is best suited for routine matters and simple questions. You should not send us e-mail for
urgent or emergency situations or for matters requiring an immediate response. Your provider will attempt
to read and respond promptly to e-mail but cannot guarantee that any particular e-mail will be
read and responded to within any particular period of time. Time sensitive issues should be taken care
of by telephone.
• Please do not use e-mail for communications regarding sensitive health information, such as sexually
transmitted diseases, AIDS/HIV, mental health or substance abuse.
• Please include your full name, birthdate and telephone number in all e-mails. List the subject of
your e-mail in the “Subject” line of your message.
• All e-mails between you and your provider regarding diagnosis or treatment will be printed and
made part of your permanent health information.
• Your provider may forward your e-mail to other staff members as necessary for response. However,
your e-mail will not be forwarded outside of our practice without your authorization.
• In order to prevent the introduction of computer viruses into our system, do not send attachments to
us in your e-mail.
• You are responsible for protecting your password or other means of access to e-mail.

By typing your name here, you agree to the above statements.