202-558-5312

Intake Form

Effective Date: July 2026

  1. Information We Collect

    We may collect personal information that you voluntarily provide, including:

    • Full name
    • Mobile phone number
    • Email address
    • Mailing address
    • Date of birth (when applicable)
    • Insurance information (when applicable)
    • Information submitted through appointment requests, referral forms, contact forms, or other communications
  2. How We Use Your Information

    We use your information to:

    • Schedule and confirm appointments
    • Coordinate patient care
    • Respond to inquiries
    • Send appointment reminders
    • Send referral and care coordination updates
    • Send account notifications
    • Communicate regarding healthcare services
    • Improve our services and website
  3. Information Sharing

    Founding Fathers Medical House Calls does not sell, rent, or disclose your personal information to third parties for marketing purposes.

    We may share information only:

    • To provide the requested healthcare services
    • With authorized healthcare providers involved in your care
    • To comply with applicable laws and regulations
    • As otherwise permitted under HIPAA and applicable federal or state law

    Phone numbers and SMS consent are never shared, sold, rented, or disclosed to third parties or affiliates for marketing purposes. SMS consent is used solely for communications from Founding Fathers Medical House Calls.

  4. SMS Communications

    If you choose to opt in, you may receive SMS text messages regarding:

    • Appointment reminders
    • Appointment confirmations
    • Home visit scheduling
    • Referral updates
    • Care coordination
    • Medication reminders
    • Healthcare-related notifications
    • Account notifications
    • Customer service communications

    Refer to our full SMS Terms of Service for more information.

  5. Data Security

    We maintain reasonable administrative, technical, and physical safeguards to protect your personal information against unauthorized access, disclosure, alteration, or destruction.

  6. Your Rights

    You may opt out of SMS communications at any time by replying STOP to any message.

    For assistance, reply HELP or contact our office.

  7. Contact Information

    Founding Fathers Medical House Call

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