Client Forms
If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.
If you feel that you would like to collaborate your session with another provider, simply fill out the following form.
PRIVACY POLICY
Mind & Body Healing Collective, LLC (the “Practice”) is committed to protecting your privacy.
Privacy Policy - SMS MESSAGES
“Mobile opt in SMS consent and phone numbers will not be shared or sold to any third party or affiliates for marketing purposes.”
Key elements required in the Privacy Policy:
We collect information about you via our online portal and Electronic Health Records that you fill out as a client or patient.
Your address, phone and email are collected for our records.
Information is only used to communicate with the client as needed for clinical care and/or scheduling or questions with the provider. We do not solicit clients.
No information is ever shared with any 3rd parties. These are medical records and are confidential.
2. SMS Consent Checkbox
The box to opt into SMS communication is on the Consent form in our online documents in the EHR records.
3. Terms & SMS Communications Disclosure
Upon providing consent, the customer’s phone number and consent will remain confidential and will not be shared or sold to third parties or affiliates for marketing purposes. The information will only be used to facilitate communication.
4. Terms and Conditions
SMS Terms of Service By opting into SMS from a portal forms or other medium, you are agreeing to receive SMS messages from Mind & Body Healing Collective. This includes SMS messages for conversations (external). Message frequency varies. Message and data rates may apply.
Types of SMS Messages
After consent is obtained, the following messages may be sent:
Appointment Reminders
Communication regarding scheduling or client care.
Example Message:
“Hi [Customer Name], this is a reminder of your upcoming appointment with [Business Name] on [Date] at [Time]. We look forward to seeing you!”
Standard Messaging Disclosures
Reply STOP to unsubscribe
Reply HELP for assistance
Message and data rates may apply
Messaging frequency may vary depending upon when you have appointments scheduled with our providers.
Sample HELP Response:
“For further assistance, please visit our website at www.mbhealingcollective.org or contact us at 785.615.1995"
Opt-In Methods
Users may opt in via:
Online forms through patient portal
Paper forms if someone cannot use patient portal
Opt-Out Methods
Users may opt out at any time by:
Replying STOP to any SMS message
Contacting your business directly to request removal
Additional Option: Users who do not wish to receive SMS messages may simply leave the SMS consent checkbox unchecked.
Consent to Communicate via Text Messaging
Mind & Body Healing Collective offers text messaging as a convenience for administrative and care-coordination communication. We utilize RingCentral as our secure telecommunications carrier.
Consent to Receive Text Messages Client consent to receive text messages is obtained through our secure Electronic Health Record (EHR) system, TherapyNotes, via the client portal. Consent is provided by completing and submitting the appropriate consent form online. By signing this form, clients acknowledge and agree to receive text communications related to scheduling, billing, appointment reminders, and other non-clinical matters.
Client-Initiated Text Communication If a client initiates communication by texting our office, this action constitutes consent for us to respond via text to that inquiry, in accordance with applicable regulations.
Important Communication Notes Text messaging is not used for emergencies, crisis communication, or detailed clinical discussions. Standard messaging and data rates may apply depending on your mobile carrier. Clients may opt out of text messaging at any time by updating their preferences in the TherapyNotes client portal or by notifying our office in writing.
We are committed to protecting your privacy and communicating with care, clarity, and respect.