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Patient Consent for Use and Disclosure of Protected Health Information
I hereby give my consent for Acupuncture & Integrative Medicine of Maryland to use and disclose protected health information (PHI) about me to carry out treatment, payment and health care operations (TPO).
I have the right to review the Notice of Privacy Practices prior to signing this consent.  Acupuncture & Integrative Medicine of Maryland reserves the right to revise its Notice of Privacy Practices at any time. A revised Notice of Privacy Practices may be obtained by forwarding a  written request to info@aimmaryland.com.
With this consent, Acupuncture & Integrative Medicine of Maryland may call my home, other alternative location, or text my mobile phone, and leave a message on voice mail or in person in reference to any items that assist the practice in carrying out TPO, such as appointment reminders, insurance items and any calls pertaining to my clinical care, including laboratory test results, among others.
With this consent, Acupuncture & Integrative Medicine of Maryland may mail to my home or other alternative location any items that assist the practice in carrying out TPO, such as appointment reminder cards and patient statements as long as they are marked “Personal and Confidential.”
With this consent, Acupuncture & Integrative Medicine of Maryland may send e-mail to my home or other alternative location any items that assist the practice in carrying out TPO, such as appointment reminder cards and patient statements. I have the right to request that Acupuncture & Integrative Medicine of Maryland restrict how it uses or discloses my PHI to carry out TPO. The practice is not required to agree to my requested restrictions, but if it does, it is bound by this agreement.
By signing this form, I am consenting to allow Acupuncture & Integrative Medicine of Maryland to use and disclose my PHI to carry out TPO.
I may revoke my consent in writing except to the extent that the practice has already made disclosures in reliance upon my prior consent. If I do not sign this consent, or later revoke it, Acupuncture & Integrative Medicine of Maryland may decline to provide treatment to me.

All Ages Acupuncture, LLC dba Acupuncture & Integrative Medicine of Maryland Privacy Policy / Terms and Conditions. 
All Ages Acupuncture, LLC dba Acupuncture & Integrative Medicine of Maryland Privacy Policy  respects your privacy. By opting into our SMS messaging service, you agree to the following terms regarding how we handle your data:

Data Collection: We will collect your name, email address, and mobile phone number when you sign up for SMS updates. This information will be gathered in person at our physical location or over the phone if our customers call our business line.

Data Usage: We use your data solely to provide appointment notifications, customer care responses and delivery notices for test results. 

Data Security: We protect your data with secure storage measures to prevent unauthorized access.

Data Retention: We retain your information as long as you are subscribed to our SMS service. You may request deletion at any time.

Message and Data Rates may apply: Your mobile carrier may charge fees for sending or receiving text messages, especially if you do not have an unlimited texting or data plan. Messages are recurring and message frequency varies.

Contact Acupuncture & Integrative Medicine of Maryland at (410) 864-0210 or info@aimmaryland.com for HELP or to STOP receiving messages.

Opt-Out: You can opt out of the SMS list at any time by texting, emailing, or replying STOP or CANCEL to info@aimmaryland.com or (410) 864-0210. After unsubscribing, you will receive a final SMS to confirm you have unsubscribed and we will remove your number from our list within 24 hours.

HELP: You can send HELP for additional assistance, and you will receive a text including our phone number, email address, and website. We are here to help you.

Non-Sharing Clauses: Acupuncture & Integrative Medicine of Maryland does not share your data with third parties for marketing purposes. Acupuncture & Integrative Medicine of Maryland does not sell, rent, or share the collected mobile numbers or mobile opt-in information with anyone.

SMS CONSENT PRIVACY POLICY

Non-Sharing Clauses: Acupuncture & Integrative Medicine of Maryland does not share your data with third parties for marketing purposes. Acupuncture & Integrative Medicine of Maryland does not sell, rent, or share the collected mobile numbers or mobile opt-in information with anyone.

Data Collection: We will collect your name, email address, and mobile phone number when you sign up for SMS updates. This information will be gathered in person at our physical location or over the phone if our customers call our business line.

Data Usage: We use your data solely to provide appointment reminders, insurance items and any calls pertaining to your clinical care, including laboratory test results, among other messages exclusively for our clinic services. This service is not intended to send marketing communication.

Data Security: We protect your data with secure storage measures to prevent unauthorized access.

Data Retention: We retain your information as long as you are subscribed to our SMS service. You may request deletion at any time.

Message and Data Rates may apply: Your mobile carrier may charge fees for sending or receiving text messages, especially if you do not have an unlimited texting or data plan. Messages are recurring and message frequency varies.

Contact Acupuncture & Integrative Medicine of Maryland at (410) 864-0210 or info@aimmaryland.com for HELP or to STOP receiving messages.

Opt-Out: You can opt out of the SMS list at any time by texting, emailing, or replying STOP to info@aimmaryland.com or (410) 864-0210. After unsubscribing, you will receive a final SMS to confirm you have unsubscribed and we will remove your number from our list within 24 hours. You can send HELP for additional assistance, and you will receive a text including our phone number, email address, and website. We are here to help you.

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