Join the Registry

email Consent

In response to recently enacted rules designed to maintain the privacy of your confidential medical information, the University of Rochester Medical Center has implemented a policy concerning the use of email as a communication tool between healthcare providers and patients. This policy has a direct impact on the National Registry as well.

From this point on, if you wish to exchange information with the Registry via email, you will need to sign a consent form that gives us permission to do so. This form, the Patient Email Consent Form must be signed by both you and the Registry staff. The form is an acknowledgement of the risks, responsibilities and the type of information that is appropriate to be relayed via email.

To obtain a copy of this form, please contact the Registry office or download a copy by clicking on the link above. Please return a signed copy to the Registry office through mail or by faxing the form to us at 585-273-1255. We will return a signed copy of this form to you for your files. If you have any questions or concerns regarding this policy, please do not hesitate to contact us.

Updated 9/12/2006