ContractConsent and Disclosure Agreement • May 6th, 2019
This Consent and Disclosure Agreement, between United Northwest Federal Credit Union (hereinafter “we, us, our or Credit Union”), and each participating member of the Credit Union’s Online Services program, together with any person who is authorized by a member to use or access this service (hereinafter referred together as “you, your, or yours”), provides important information required by the Electronic Signatures in Global and National Commerce Act (E-SIGN Act) and applies to your consent to, and your request for, the electronic delivery of all Communications for and relating to your membership and the accounts, products, and services offered and/or accessible through Credit Union online services. Those services include, but may not be limited to, Online Banking, E-Statements, External Transfers, Bill Payment, and Remote Deposit Capture (Mobile Deposit) Services, as well as access to those online services via our Mobile Banking Application.
Consent and Disclosure Agreement for Healthful Life MD Virtual Support GroupsConsent and Disclosure Agreement • October 15th, 2021
Dr. Tonya McFarland is a licensed psychologist and will be facilitating the support groups. These support groups will be offered once monthly through Healthful Life MD. The purpose of Healthful Life MD virtual support groups is to provide psychoeducation and support. These support groups are not to be considered therapeutic in nature, as they only provide support and education. If you are wanting therapy, referrals to mental health providers can be provided. The support groups will provided using a HIPAA compliant virtual video platform, such as Zoom.
Tele-mental Health Informed Consent and Disclosure AgreementConsent and Disclosure Agreement • August 15th, 2016
Secure and private communication, as well as one’s confidentiality, cannot be guaranteed when utilizing cell phones, smart phones or regular email systems. It is the client’s right to determine whether communication using non-secure technologies may be permitted and under what circumstances. Use of any non-secure technology to contact Jennifer Tardelli, LPC in this consent form shall be considered an implied consent to return messages to the client via the same non-secure technology, pending further clarification for the client.
eStatement Consent and Disclosure Agreement (Agreement to Receive or Access Electronic Disclosures (eDisclosures), Notices (eNotices) and Statements (eStatements))Consent and Disclosure Agreement • March 9th, 2017
This eStatement Consent and Disclosure Agreement (“Agreement”) allows us to provide you with electronic versions of important disclosures, notices and statements that apply to your accounts. Certain laws and regulations require us to provide notices and disclosures to you in “writing”, and with your consent to this Agreement the E-Sign Act allows us to provide these documents to you electronically.
