The Salerno Center For Complementary Medicine
345 East 37th St Ste 208 New York, NY 10016 Telephone: 212.582.1700 Fax: 212.582.1727
EMAIL CONSENT
herby consent to have my physician Dr. John P. Salerno,
communicate with me or members of his staff, where appropriate or other physicians, nurse practitioners, registered nurses, medical assistants and pharmacist via e-mailing regarding the following aspects of my medical care and treatment: [test results, prescriptions, appointments, billing. Etc.l
I understand that email is not a confidential method of communication, i further understand that there is a risk
that email communication between my physician and I, or members of the physician's office staff or between my physician or other physicians, nurse practitioners and pharmacists regarding my medical care and treatment may be intercepted by third parties or transmitted to unintended parties.
I also understand that any e-mail communication between my physician and I, or members of his staff, or
between my physician and other physicians, nurse practitioners or pharmacist regarding my medical care and treatment will be printed out and made a part my medical record.
I understand that in an emergent situation I should call the provider or go to the Emergency Room and not rely on e-mail.