Online Booking
help_outline
How it Works
On this page, you can define what information customers should enter when booking an appointment with you through Sign In Scheduling. You can also accept payments and set up notifications.
Click here for more support material: How to customize your booking process | Managing customers’ consent using opt-ins
cancel
Settings
Apply changes to:
All services
Customer information entry
Change the questions that customers must answer during booking
Are customers required to provide email during booking?
Are customers required to provide phone number during booking?
Add New Question
Consent & Opt-in Questions
Change the questions asking for consent during booking. For example, if you run a mailing list, you can ask the customer for consent to be added to it.
addAdd
Opt-in Name
Consent to contact
Question
Permission to use your information to contact you about your bookings and agreement to our Privacy Policy
Mandatory during customers booking
Require this opt-in to send:
SMS
Email
Voice
WhatsApp
Note that customers who have not consented to this opt-in will not receive some communications
Status
Live
Delete
Opt-in Name
Hipaa t
Question
Online Booking
help_outline
How it Works
On this page, you can define what information customers should enter when booking an appointment with you through Sign In Scheduling. You can also accept payments and set up notifications.
Click here for more support material: How to customize your booking process | Managing customers’ consent using opt-ins
cancel
Settings
Apply changes to:
All services
Customer information entry
Change the questions that customers must answer during booking
Are customers required to provide email during booking?
Are customers required to provide phone number during booking?
Add New Question
Consent & Opt-in Questions
Change the questions asking for consent during booking. For example, if you run a mailing list, you can ask the customer for consent to be added to it.
Add
Opt-in Name
Consent to contact
Question
Permission to use your information to contact you about your bookings and agreement to our Privacy Policy
Mandatory during customers booking
Require this opt-in to send:
SMS
Email
Voice
WhatsApp
Note that customers who have not consented to this opt-in will not receive some communications
Status
Live
Delete
Opt-in Name
Hipaa consent to contact
Question
HIPAA Compliance Patient Consent Form
Our Notice of Privacy Practices provides information about how we may use or disclose protected health information.
The notice contains a patient’s rights section describing your rights under the law. You ascertain that by your signature that you have reviewed our notice before signing this consent.
The terms of the notice may change, if so, you will be notified at your next visit to update your signature/date.
You have the right to restrict how your protected health information is used and disclosed for treatment, payment or healthcare operations. We are not required to agree with this restriction, but if we do, we shall honor this agreement. The HIPAA (Health Insurance Portability and Accountability Act of 1996) law allows for the use of the information for treatment, payment, or healthcare operations.
By signing this form, you consent to our use and disclosure of your protected healthcare information and potentially anonymous usage in a publication. You have the right to revoke this consent in writing, signed by you. However, such a revocation will not be retroactive.
By agreeing to this form, I understand that:
Protected health information may be disclosed or used for treatment, payment, or healthcare operations.
The practice reserves the right to change the privacy policy as allowed by law.
The practice has the right to restrict the use of the information but the practice does not have to agree to those restrictions.
The patient has the right to revoke this consent in writing at any time and all full disclosures will then cease.
The practice may condition receipt of treatment upon execution of this consent.
May we phone, email, or send a text to you to confirm appointments?
YES
NO
May we leave a message on your answering machine at home or on your cell phone?
YES
NO
If at anytime you wish to opt out of this service you may deselect the box or call or text 8632680580 and request to be removed
