{"id":317,"date":"2026-03-17T15:13:16","date_gmt":"2026-03-17T15:13:16","guid":{"rendered":"https:\/\/www.change-in-entropy.com\/?page_id=317"},"modified":"2026-03-17T15:13:46","modified_gmt":"2026-03-17T15:13:46","slug":"sms-and-email-communication-consent","status":"publish","type":"page","link":"https:\/\/www.change-in-entropy.com\/index.php\/sms-and-email-communication-consent\/","title":{"rendered":"SMS and Email Communication Consent"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"317\" class=\"elementor elementor-317\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9937a7c e-flex e-con-boxed e-con e-parent\" data-id=\"9937a7c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2a32f77 elementor-widget elementor-widget-text-editor\" data-id=\"2a32f77\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"729\" data-end=\"887\"><strong data-start=\"729\" data-end=\"763\">Change in Entropy Hypnotherapy<\/strong><br data-start=\"763\" data-end=\"766\" \/><strong data-start=\"766\" data-end=\"778\">Website:<\/strong> <a class=\"decorated-link\" href=\"https:\/\/www.change-in-entropy.com\/\" target=\"_new\" rel=\"noopener\" data-start=\"779\" data-end=\"813\">https:\/\/www.change-in-entropy.com\/<\/a><br data-start=\"813\" data-end=\"816\" \/><strong data-start=\"816\" data-end=\"835\">Effective Date:<\/strong> March 17, 2026<br data-start=\"850\" data-end=\"853\" \/><strong data-start=\"853\" data-end=\"870\">Last Updated:<\/strong> March 17, 2026<\/p><p data-start=\"889\" data-end=\"1070\"><strong data-start=\"889\" data-end=\"921\">Practice Contact Information<\/strong><br data-start=\"921\" data-end=\"924\" \/>Change in Entropy Hypnotherapy<br data-start=\"954\" data-end=\"957\" \/>2862 Change Street, Unit A<br data-start=\"983\" data-end=\"986\" \/>Los Alamos, NM 87544<br data-start=\"1006\" data-end=\"1009\" \/>Email: <a class=\"decorated-link cursor-pointer\" rel=\"noopener\" data-start=\"1016\" data-end=\"1046\">jennifer@change-in-entropy.com<\/a><br data-start=\"1046\" data-end=\"1049\" \/>Phone: (907) 278-1180<\/p><h2 data-section-id=\"k5zitr\" data-start=\"1072\" data-end=\"1096\">1. Client Information<\/h2><p data-start=\"1098\" data-end=\"1160\"><strong data-start=\"1098\" data-end=\"1119\">Client Full Name:<\/strong> ________________________________________<\/p><p data-start=\"1162\" data-end=\"1225\"><strong data-start=\"1162\" data-end=\"1180\">Date of Birth:<\/strong> ____________________________________________<\/p><p data-start=\"1227\" data-end=\"1288\"><strong data-start=\"1227\" data-end=\"1244\">Phone Number:<\/strong> ___________________________________________<\/p><p data-start=\"1290\" data-end=\"1352\"><strong data-start=\"1290\" data-end=\"1308\">Email Address:<\/strong> ___________________________________________<\/p><h2 data-section-id=\"hcmoo6\" data-start=\"1354\" data-end=\"1383\">2. Purpose of This Consent<\/h2><p data-start=\"1385\" data-end=\"1639\">This form allows you to choose whether Change in Entropy Hypnotherapy may communicate with you by <strong data-start=\"1483\" data-end=\"1505\">text message (SMS)<\/strong> and <strong data-start=\"1510\" data-end=\"1519\">email<\/strong> for routine administrative and care-related matters, and separately for any optional marketing or promotional messages.<\/p><p data-start=\"1641\" data-end=\"1714\">Please read each section carefully and initial only the options you want.<\/p><h2 data-section-id=\"jhunrf\" data-start=\"1716\" data-end=\"1774\">3. Important Information About Email and Text Messaging<\/h2><p data-start=\"1776\" data-end=\"2022\">Email and text messaging can be convenient, but they also involve privacy and security risks. Messages may be delayed, intercepted, misdirected, viewed by others who access your phone, email account, or device, or stored by your service provider.<\/p><p data-start=\"2024\" data-end=\"2149\">If you request or permit email or text communications, you acknowledge and accept these risks to the extent permitted by law.<\/p><p data-start=\"2151\" data-end=\"2193\">These methods are <strong data-start=\"2169\" data-end=\"2192\">not for emergencies<\/strong>.<\/p><p data-start=\"2195\" data-end=\"2417\">Do not use email or text message for urgent medical, mental health, or safety concerns. If you are in immediate danger or need emergency help, call <strong data-start=\"2343\" data-end=\"2350\">911<\/strong>. If you are in emotional distress or crisis, call or text <strong data-start=\"2409\" data-end=\"2416\">988<\/strong>.<\/p><h2 data-section-id=\"sjtwb6\" data-start=\"2419\" data-end=\"2479\">4. Routine Administrative and Care-Related Communications<\/h2><p data-start=\"2481\" data-end=\"2514\">These communications may include:<\/p><ul data-start=\"2516\" data-end=\"2777\"><li data-section-id=\"11o72ca\" data-start=\"2516\" data-end=\"2539\"><p data-start=\"2518\" data-end=\"2539\">appointment reminders<\/p><\/li><li data-section-id=\"1dd6u3e\" data-start=\"2540\" data-end=\"2577\"><p data-start=\"2542\" data-end=\"2577\">scheduling or rescheduling messages<\/p><\/li><li data-section-id=\"11xcb7n\" data-start=\"2578\" data-end=\"2609\"><p data-start=\"2580\" data-end=\"2609\">intake or paperwork reminders<\/p><\/li><li data-section-id=\"1cqn13t\" data-start=\"2610\" data-end=\"2640\"><p data-start=\"2612\" data-end=\"2640\">billing or payment reminders<\/p><\/li><li data-section-id=\"2l1lm0\" data-start=\"2641\" data-end=\"2673\"><p data-start=\"2643\" data-end=\"2673\">requests to contact the office<\/p><\/li><li data-section-id=\"1251p3u\" data-start=\"2674\" data-end=\"2723\"><p data-start=\"2676\" data-end=\"2723\">limited care coordination or follow-up messages<\/p><\/li><li data-section-id=\"13f2kg6\" data-start=\"2724\" data-end=\"2777\"><p data-start=\"2726\" data-end=\"2777\">notices about office closures or scheduling changes<\/p><\/li><\/ul><p data-start=\"2779\" data-end=\"2813\">Please initial your choices below:<\/p><p data-start=\"2815\" data-end=\"3098\"><strong data-start=\"2815\" data-end=\"2881\">SMS for routine administrative and care-related communications<\/strong><br data-start=\"2881\" data-end=\"2884\" \/>_____ YES, I consent to receive routine administrative and care-related text messages at the phone number listed above.<br data-start=\"3003\" data-end=\"3006\" \/>_____ NO, I do not consent to receive routine administrative and care-related text messages.<\/p><p data-start=\"3100\" data-end=\"3372\"><strong data-start=\"3100\" data-end=\"3168\">Email for routine administrative and care-related communications<\/strong><br data-start=\"3168\" data-end=\"3171\" \/>_____ YES, I consent to receive routine administrative and care-related emails at the email address listed above.<br data-start=\"3284\" data-end=\"3287\" \/>_____ NO, I do not consent to receive routine administrative and care-related emails.<\/p><h2 data-section-id=\"7cyhss\" data-start=\"3374\" data-end=\"3420\">5. Marketing and Promotional Communications<\/h2><p data-start=\"3422\" data-end=\"3474\">Marketing or promotional communications may include:<\/p><ul data-start=\"3476\" data-end=\"3651\"><li data-section-id=\"11uybsa\" data-start=\"3476\" data-end=\"3489\"><p data-start=\"3478\" data-end=\"3489\">newsletters<\/p><\/li><li data-section-id=\"1kb8t3u\" data-start=\"3490\" data-end=\"3556\"><p data-start=\"3492\" data-end=\"3556\">announcements about new services, programs, workshops, or events<\/p><\/li><li data-section-id=\"1eahdfd\" data-start=\"3557\" data-end=\"3620\"><p data-start=\"3559\" data-end=\"3620\">educational updates not directly related to your current care<\/p><\/li><li data-section-id=\"1610ojs\" data-start=\"3621\" data-end=\"3651\"><p data-start=\"3623\" data-end=\"3651\">general promotions or offers<\/p><\/li><\/ul><p data-start=\"3653\" data-end=\"3755\">You are <strong data-start=\"3661\" data-end=\"3677\">not required<\/strong> to consent to marketing or promotional messages in order to receive services.<\/p><p data-start=\"3757\" data-end=\"3791\">Please initial your choices below:<\/p><p data-start=\"3793\" data-end=\"4056\"><strong data-start=\"3793\" data-end=\"3833\">SMS marketing \/ promotional messages<\/strong><br data-start=\"3833\" data-end=\"3836\" \/>_____ YES, I consent to receive promotional or marketing text messages from Change in Entropy Hypnotherapy at the phone number listed above.<br data-start=\"3976\" data-end=\"3979\" \/>_____ NO, I do not consent to receive promotional or marketing text messages.<\/p><p data-start=\"4058\" data-end=\"4310\"><strong data-start=\"4058\" data-end=\"4100\">Email marketing \/ promotional messages<\/strong><br data-start=\"4100\" data-end=\"4103\" \/>_____ YES, I consent to receive promotional or marketing emails from Change in Entropy Hypnotherapy at the email address listed above.<br data-start=\"4237\" data-end=\"4240\" \/>_____ NO, I do not consent to receive promotional or marketing emails.<\/p><h2 data-section-id=\"1l5cynw\" data-start=\"4312\" data-end=\"4340\">6. Message and Data Rates<\/h2><p data-start=\"4342\" data-end=\"4521\">Standard message and data rates from your wireless or internet provider may apply to text messages or emails accessed on a mobile device. You are responsible for any such charges.<\/p><h2 data-section-id=\"pxd6nd\" data-start=\"4523\" data-end=\"4550\">7. Frequency of Messages<\/h2><p data-start=\"4552\" data-end=\"4690\">Message frequency will vary depending on your appointments, communications preferences, and any programs or updates you choose to receive.<\/p><h2 data-section-id=\"ops4gg\" data-start=\"4692\" data-end=\"4731\">8. Alternative Communication Methods<\/h2><p data-start=\"4733\" data-end=\"4880\">If you do not want email or text messages, or if you want to limit the type of messages you receive, alternative communication methods may include:<\/p><ul data-start=\"4882\" data-end=\"4965\"><li data-section-id=\"1xfxys6\" data-start=\"4882\" data-end=\"4894\"><p data-start=\"4884\" data-end=\"4894\">phone call<\/p><\/li><li data-section-id=\"15leus7\" data-start=\"4895\" data-end=\"4906\"><p data-start=\"4897\" data-end=\"4906\">voicemail<\/p><\/li><li data-section-id=\"1elwj1w\" data-start=\"4907\" data-end=\"4920\"><p data-start=\"4909\" data-end=\"4920\">postal mail<\/p><\/li><li data-section-id=\"h4hrql\" data-start=\"4921\" data-end=\"4965\"><p data-start=\"4923\" data-end=\"4965\">secure portal or secure form, if available<\/p><\/li><\/ul><p data-start=\"4967\" data-end=\"5032\"><strong data-start=\"4967\" data-end=\"5002\">Preferred communication method:<\/strong> _____________________________<\/p><p data-start=\"5034\" data-end=\"5097\"><strong data-start=\"5034\" data-end=\"5061\">Preferred phone number:<\/strong> ___________________________________<\/p><p data-start=\"5099\" data-end=\"5163\"><strong data-start=\"5099\" data-end=\"5127\">Preferred email address:<\/strong> ___________________________________<\/p><h2 data-section-id=\"36xsdy\" data-start=\"5165\" data-end=\"5204\">9. Revoking or Changing Your Consent<\/h2><p data-start=\"5206\" data-end=\"5256\">You may change or revoke this consent at any time.<\/p><p data-start=\"5258\" data-end=\"5289\">To stop text messages, you may:<\/p><ul data-start=\"5291\" data-end=\"5457\"><li data-section-id=\"1b3wqi\" data-start=\"5291\" data-end=\"5341\"><p data-start=\"5293\" data-end=\"5341\">reply <strong data-start=\"5299\" data-end=\"5307\">STOP<\/strong> to a text message where available<\/p><\/li><li data-section-id=\"sj7j92\" data-start=\"5342\" data-end=\"5374\"><p data-start=\"5344\" data-end=\"5374\">notify the practice in writing<\/p><\/li><li data-section-id=\"rnusg1\" data-start=\"5375\" data-end=\"5414\"><p data-start=\"5377\" data-end=\"5414\">call the office at <strong data-start=\"5396\" data-end=\"5414\">(907) 278-1180<\/strong><\/p><\/li><li data-section-id=\"1qbqbkm\" data-start=\"5415\" data-end=\"5457\"><p data-start=\"5417\" data-end=\"5457\">email <strong data-start=\"5423\" data-end=\"5457\"><a class=\"decorated-link cursor-pointer\" rel=\"noopener\" data-start=\"5425\" data-end=\"5455\">jennifer@change-in-entropy.com<\/a><\/strong><\/p><\/li><\/ul><p data-start=\"5459\" data-end=\"5605\">To unsubscribe from marketing emails, you may use the unsubscribe method included in the email where applicable, or contact the practice directly.<\/p><p data-start=\"5607\" data-end=\"5707\">Revocation of consent will not affect communications already sent before your request was processed.<\/p><h2 data-section-id=\"vi6x84\" data-start=\"5709\" data-end=\"5744\">10. Limits on Email and Text Use<\/h2><p data-start=\"5746\" data-end=\"5827\">The practice may choose not to use email or text for certain subjects, including:<\/p><ul data-start=\"5829\" data-end=\"6018\"><li data-section-id=\"1ox6ow7\" data-start=\"5829\" data-end=\"5842\"><p data-start=\"5831\" data-end=\"5842\">emergencies<\/p><\/li><li data-section-id=\"1lo5alx\" data-start=\"5843\" data-end=\"5895\"><p data-start=\"5845\" data-end=\"5895\">highly sensitive or extensive clinical discussions<\/p><\/li><li data-section-id=\"1kxlszf\" data-start=\"5896\" data-end=\"5960\"><p data-start=\"5898\" data-end=\"5960\">complex treatment issues better handled in session or by phone<\/p><\/li><li data-section-id=\"j24iia\" data-start=\"5961\" data-end=\"6018\"><p data-start=\"5963\" data-end=\"6018\">matters requiring secure documents or formal signatures<\/p><\/li><\/ul><p data-start=\"6020\" data-end=\"6126\">The practice may instead ask you to schedule an appointment, use a secure method, or communicate by phone.<\/p><h2 data-section-id=\"k2kh6d\" data-start=\"6128\" data-end=\"6156\">11. Client Acknowledgment<\/h2><p data-start=\"6158\" data-end=\"6195\">By signing below, I acknowledge that:<\/p><ol data-start=\"6197\" data-end=\"6626\"><li data-section-id=\"1rt8a2g\" data-start=\"6197\" data-end=\"6270\"><p data-start=\"6200\" data-end=\"6270\">I have read and understand this SMS and Email Communication Consent.<\/p><\/li><li data-section-id=\"1vtennx\" data-start=\"6271\" data-end=\"6370\"><p data-start=\"6274\" data-end=\"6370\">I understand the risks of email and text communications, including privacy and security risks.<\/p><\/li><li data-section-id=\"dx7dy0\" data-start=\"6371\" data-end=\"6445\"><p data-start=\"6374\" data-end=\"6445\">I understand that email and text are not appropriate for emergencies.<\/p><\/li><li data-section-id=\"sbw2p7\" data-start=\"6446\" data-end=\"6520\"><p data-start=\"6449\" data-end=\"6520\">I understand that I may refuse, limit, or revoke consent at any time.<\/p><\/li><li data-section-id=\"1fneord\" data-start=\"6521\" data-end=\"6626\"><p data-start=\"6524\" data-end=\"6626\">I understand that I am not required to agree to marketing communications in order to receive services.<\/p><\/li><\/ol><h2 data-section-id=\"7j54z0\" data-start=\"6628\" data-end=\"6644\">12. Signature<\/h2><p data-start=\"6646\" data-end=\"6707\"><strong data-start=\"6646\" data-end=\"6662\">Client Name:<\/strong> ____________________________________________<\/p><p data-start=\"6709\" data-end=\"6772\"><strong data-start=\"6709\" data-end=\"6730\">Client Signature:<\/strong> _________________________________________<\/p><p data-start=\"6774\" data-end=\"6835\"><strong data-start=\"6774\" data-end=\"6783\">Date:<\/strong> ___________________________________________________<\/p><h2 data-section-id=\"12jwhpo\" data-start=\"6837\" data-end=\"6882\">13. Personal Representative, if Applicable<\/h2><p data-start=\"6884\" data-end=\"6949\"><strong data-start=\"6884\" data-end=\"6920\">Name of Personal Representative:<\/strong> ____________________________<\/p><p data-start=\"6951\" data-end=\"7015\"><strong data-start=\"6951\" data-end=\"6978\">Relationship to Client:<\/strong> ____________________________________<\/p><p data-start=\"7017\" data-end=\"7083\"><strong data-start=\"7017\" data-end=\"7049\">Authority to Act for Client:<\/strong> _________________________________<\/p><p data-start=\"7085\" data-end=\"7151\"><strong data-start=\"7085\" data-end=\"7126\">Signature of Personal Representative:<\/strong> ________________________<\/p><p data-start=\"7153\" data-end=\"7214\"><strong data-start=\"7153\" data-end=\"7162\">Date:<\/strong> ___________________________________________________<\/p><h2 data-section-id=\"1yv31qa\" data-start=\"7216\" data-end=\"7240\">14. Practice Use Only<\/h2><p data-start=\"7242\" data-end=\"7303\"><strong data-start=\"7242\" data-end=\"7259\">Processed By:<\/strong> ___________________________________________<\/p><p data-start=\"7305\" data-end=\"7366\"><strong data-start=\"7305\" data-end=\"7322\">Date Entered:<\/strong> ___________________________________________<\/p><p data-start=\"7368\" data-end=\"7432\"><strong data-start=\"7368\" data-end=\"7393\">Notes \/ Restrictions:<\/strong> ______________________________________<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Change in Entropy HypnotherapyWebsite: https:\/\/www.change-in-entropy.com\/Effective Date: March 17, 2026Last Updated: March 17, 2026 Practice Contact InformationChange in Entropy Hypnotherapy2862 Change Street, Unit ALos Alamos, NM 87544Email: jennifer@change-in-entropy.comPhone: (907) 278-1180 1. Client Information Client Full Name: ________________________________________ Date of Birth: ____________________________________________ Phone Number: ___________________________________________ Email Address: ___________________________________________ 2. Purpose of This Consent This form allows you [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-317","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/pages\/317","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/comments?post=317"}],"version-history":[{"count":3,"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/pages\/317\/revisions"}],"predecessor-version":[{"id":320,"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/pages\/317\/revisions\/320"}],"wp:attachment":[{"href":"https:\/\/www.change-in-entropy.com\/index.php\/wp-json\/wp\/v2\/media?parent=317"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}