Personal Information Provided

You understand and agree that any cellular, land line phone numbers, and email addresses provided by yourself to this office and to any of our services providers, now and in the future, may be used as a means to contact you. The office and any coordinating providers may leave voice messages, texts, or emails by means of contacting you. In the future, should you acquire a new or different cellular, landline or email address, you understand it is your responsibility to update your office with that information and this consent would stay effective.

These policies help the office provide quality care to our valued patients.
If you have any questions or need clarification of any of the above policies, please feel free to contact us.


I agree to abide by the policies of the office and understand that if I do not, I may be asked to seek care elsewhere.

Acknowledgement Signature Required on Demographic Form.

East Lincoln Family Health Professionals, PC. RESERVES THE RIGHT TO CHANGE AND/OR MODIFY THE INFORMATION ON THIS SITE AT ANY TIME.

Same Day Services Available!