COMPLETE CARDIOLOGY CARE & ATLANTIC CARDIOVASCULAR

COMPREHENSIVE COMMUNICATION CONSENT FORM

Purpose

To obtain your consent for us to send you reminders and other health‑related notices listed below through text/voice message, standard email, and voice calls. These are transactional or health-care messages—never marketing.

Possible Reasons We May Contact You

1. Appointment-related

• Upcoming appointment confirmations or changes
• Wait-list or earlier-slot offers

2. Account & Billing

• New statement available
• Payment reminders
• Payment-plan notices

3. Care Instructions & Results

• Preparation or fasting reminders
• Lab / imaging results ready in the portal
• Discharge or post-procedure care instructions

4. Medication & Prescriptions

• Prescription refill reminders or pickup notices
• Prior-authorization updates

5. Care-Management & Follow-Up

• Chronic-condition check-ins
• Telehealth links
• Care-gap outreach
• Device check reminders

Note: This list is representative, not exhaustive. We will not use these channels for general advertising or third-party marketing without your separate, express written authorization.

Consent

By agreeing to this form, I give my consent for Complete Cardiology Care & Atlantic Cardiovascular ("the Practice") to contact me for the purposes stated above. This includes using the telephone number(s) and email address(es) I have previously provided — as well as any updated contact information I may provide in the future — through methods such as SMS, email, automated telephone-dialing systems, and phone calls. Communications may include limited protected health information (PHI) when necessary (e.g., appointment date/time or amount due), and will never include diagnosis codes or detailed clinical information.

I understand and agree that:

• Text messaging and standard email are not guaranteed to be secure methods of transmission; I accept this privacy risk.
• I can revoke this consent at any time by notifying the Practice in writing, replying “STOP” to a text, or following the opt‑out instructions in an email. Revocation will not affect communications already sent.
• My treatment, payment, enrollment, or eligibility for benefits is not conditioned on signing this form, but opting out may cause me to miss important reminders.
• This consent remains in effect until I revoke it.
• I may request a more secure channel or limit which methods are used by notifying the Practice in writing.

Certification of Ownership

I certify that I am the owner or customary user of the telephone number(s) and email address(es) I provided previously, and I agree to notify the Practice promptly if I change or relinquish any of these contact methods.

If you have any questions about this communication consent form, please contact:

Complete Cardiology Care
(386) 672-1023 Option 3
support@completecardiologycare.com