Get Patient Communication Consent Form - Dr. Benjamin Cohen

Completing the Patient Communication Consent Form for Dr. Benjamin Cohen is an essential step for enabling effective communication regarding your health information. This guide will provide you with clear and supportive instructions on how to fill out the form accurately and efficiently in an online format.

Follow the steps to effectively fill out the form.

1. Click the ‘Get Form’ button to access the Patient Communication Consent Form and open it for editing.
2. Begin by providing your consent for Dr. Cohen and his staff to contact you regarding your personal health information. This section typically includes options for preferred contact methods.
3. In the 'Method' section, indicate your preferred communication methods by checking ‘Yes’ or ‘No’ for each contact option — home phone, cell phone, work phone, alternate phone, and email. Make sure to fill in the corresponding number or address for each selected method.
4. Next, authorize Dr. Cohen and his staff to discuss your personal health information with particular individuals. Provide the names, relationships to you, and their phone numbers in the designated fields.
5. At the bottom of the form, fill in the details for your emergency contact, including their name and phone number.
6. Finally, review the form to ensure all information is accurate, then sign and date the form in the respective fields. Ensure you understand the consent you are providing regarding the methods of communication outlined in the form.
7. Once all sections are completed, save any changes, and choose to download, print, or share the form as needed.

Complete your Patient Communication Consent Form online today to facilitate your communication needs with Dr. Cohen.