Your Name (required)
Your Email (required)
Ingersoll Family Dentistry supports the use of email for the purpose of communicating with our patients regarding their clinical care.
Signing this consent form provides Ingersoll Family Dentistry with your permission to communicate with you via email and is required before we will respond to your email or send you an email for the first time.
I understand that I may stop using email for clinical communication purposes at any time, at which point I will notify Ingersoll Family Dentistry of my decision to stop using email for these purposes.
I understand that this consent remains effective unless and until it is withdrawn.
By submitting this form you agree to our consent form