The following questions are optional and do not need to be filled in but they do help us with our monthly calls and getting to know you better. If you do not choose to answer, please leave blank.
We will never contact your Providers without written permission. If you do elect to have us communicate with them regarding any concerns, we will send you a PATIENT CONSENT FORM.
By signing this document, I do give A Morning Call permission to contact my “emergency contacts” in the event I cannot be reached. I understand A Morning Call will initiate a “test”call to confirm phone numbers on my behalf before starting the program. I will let my contacts know that A Morning Calling will be reaching out to them to confirm working phone numbers.
I acknowledge that A Morning Call is not a medical service and is not liable for any injuries or emergencies sustained if I cannot be reached.