A Free, Editable Electronic Communication Consent Form

Request for Non-Secure Communication Form (Email, Texting, etc.)

Before using this form, be sure to at least read these articles (although some coursework or consultation on the related risk management issues would be most appropriate):


There are nuances to using this, and those nuances are more deeply covered in our online CE courses here: Digital Confidentiality Course Series. We strongly recommend researching and learning about the issues surrounding use of email and texting before using these media with clients.

secure communication form

20% off most everything

Find financial breathing space in your budget, peace of mind that you are moving forward in your HIPAA security compliance, and support in making a decision when things feel so unstable.

It’s not everything you need, but we hope this discount will help you feel empowered to work within your capacity.

Read our letter of love to you during this tough time

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Scheduled Maintenance

We will be temporarily taking the website offline at 10:00 PM Pacific (1:00 AM Eastern) tonight, July 6, in order to make some improvements. We plan to be back online by midnight Pacific (3:00 AM Eastern). We apologize for any inconvenience this may cause. Dismiss