Fit4D Enrollment Terms & Conditions

General Consent for Coaching Program

I request and authorize the technology-enabled health coaching services offered by Fit4D.  I understand that Fit4D services include interaction with Fit4D certified diabetes clinicians to help educate me on potential ways that I can manage my diabetes.  I understand that the education provided by Fit4D is may include education on drug therapies, lifestyle choices, and problem solving and emotional support.

I understand that Fit4D provides educational services and that in the event of an emergency I should contact my treating provider or seek emergency care services.  I understand Fit4D may release certain information about the services provided to me by my health insurance company, so that Fit4D can be reimbursed for the services provided to me.  I understand Fit4D may release certain information about the services provided to me to by my treating physician.  I acknowledge that I have been provided a copy of Fit4D’s Notice of Privacy Practices available at www.fit4d.com/notice-of-privacy-practice

SMS Text Message, Cell Phone Number, and Email Consent

In order to help better communicate with you Fit4D would like to offer you the ability to receive text messages, emails, and phone calls in order to provide you with the Fit4D educational programs.

By agreeing, you understand that information transmitted by and to you by email and text messaging is unencrypted and that as a result, it may be possible for others to intercept the information sent and received.  When Fit4D sends text messages, we will never transmit your full name or address in the text message, however we may send you information specific to your health condition. 

I understand that, if I provide my mobile phone number and email address below, I am consenting to receive text messages, emails and/or phone calls for Fit4D services as described above.  I will keep Fit4D informed of my up to date mobile number and email address at all times, and notify Fit4D the mobile number is no longer in my possession. 

 

I have read this General Consent and SMS Text Message, Cell Phone Number, and Email Consent information or it has been read to me, and I am satisfied that I understand the contents.