Consent to Use of Electronic Signatures
DMV Medical Group, LLC
P: 240-669-7496
F: 301-321-7800
Website: www.dmvmedgroup.com
1. Purpose
This Consent to Electronic Signature Agreement ("Agreement") allows DMV Medical Group, LLC to obtain your consent to use electronic signatures in place of handwritten signatures on all required forms, consents, agreements, and other documents related to your healthcare services.
By signing this Agreement electronically, you acknowledge and agree that electronic signatures hold the same legal effect as a handwritten signature in accordance with the Electronic Signatures in Global and National Commerce Act (E-SIGN Act) and applicable state laws.
2. Consent to Use Electronic Signatures
By signing this form, you acknowledge and agree to the following:
Legally Binding Signature: Your electronic signature on any document is legally binding, just as if you had signed it in person.
Scope of Use: This consent applies to all forms, consents, authorizations, agreements, and other documents required by DMV Medical Group, LLC.
Right to Paper Copies: You have the right to request a paper copy of any document you sign electronically. You may do so by contacting our office at 240-669-7496.
Right to Withdraw Consent: You have the right to withdraw your consent to electronic signatures at any time. To revoke your consent, you must notify DMV Medical Group, LLC in writing. However, withdrawing consent may affect the ability to receive certain services electronically.
Technical Requirements: You acknowledge that you have the necessary technology to receive, review, and sign electronic documents, including access to a computer or mobile device with an internet connection.
Security & Confidentiality: DMV Medical Group, LLC uses secure electronic systems to process and store electronically signed documents. You agree to keep your login credentials secure and confidential when accessing electronic documents.
3. Acknowledgment & Agreement
I have read and understand the Consent to Use of Electronic Signatures. I agree to electronically sign documents provided by DMV Medical Group, LLC and understand that my electronic signature has the same effect as a handwritten signature.
I understand that I can request a paper copy of any electronically signed document and that I have the right to withdraw my consent at any time by notifying DMV Medical Group, LLC in writing.