Contact

By submitting this form, I authorize Central Coast Men's Health to use the information I provide, including my name, email address, and phone number, to send me individualized communications about health-related services offered by the practice. These communications may include information that is considered Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). I understand these messages may be sent by phone, email, or text message and may not be encrypted. You are consenting to be contacted by SMS text message by (805) 392-8700. Message & data rates may apply. Message frequency varies. See Privacy Policy here. You can reply STOP to opt-out of further messaging. Reply Help for more information. I acknowledge the potential risks of unencrypted communications and agree to receive them anyway. I understand that I may withdraw this authorization at any time by contacting the practice or using the unsubscribe instructions provided in the communications. I understand that my treatment, payment, enrollment, or eligibility for benefits is not conditioned on my signing this authorization. This authorization will remain in effect until I revoke it in writing.