The Text Message Consent form, printed as the CLIENT TEXT MESSAGING CONSENT FORM, is a Multnomah County document that a client (or the client's guardian) signs to accept the risks and conditions of exchanging text messages with the County. It appears on the County's New Client Forms page, which asks you to complete and sign the forms before your first visit. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original is published by Multnomah County at multco.us.
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What is Text Message Consent form – Multnomah County?
The Text Message Consent form, titled CLIENT TEXT MESSAGING CONSENT FORM on the document, is the Multnomah County form in which a client acknowledges the risks of using text messaging and consents to the conditions for texting with the County.
The form has three parts. The first lists the risks of text messaging, including that text messages are not encrypted, can be forwarded, stored or received by unintended recipients, can remain as back-up copies after deletion, can be inspected by employers on employer phones, can be used as evidence in court and may be subject to public records requests.
The second part sets the conditions for use. Text messaging is not appropriate for life-threatening emergencies. Behavioral Health staff must not send any Protected Health Information by text. Clients must avoid sending personal information to Multnomah County by text. Texts may need to be transcribed into the client's services record in line with record retention requirements. Clients inform the County in writing of changes to their cell phone number and notify it in writing when they no longer want texts.
The third part is the Client Acknowledgement and Agreement, which the client or guardian signs. The form states that the County may impose other conditions on text messaging in the future.
The County lists this form beside Consent for Treatment, Release of Information and the Email Consent Form. The form is not a tax document.
Who needs to file Text Message Consent form – Multnomah County?
The main group is clients of Multnomah County who will receive or send text messages with County staff, in this form's wording the client or the client's guardian. The form has a Client/Guardian Signature line, so a guardian may sign for the client; it names no other representative.
The form is printed with BHD (Behavioral Health) staff lines at the bottom and mentions Behavioral Health staff in its conditions, so it belongs to clients who receive services through that program. The County's New Client Forms page places it among the documents new clients complete and sign before their first visit.
Consider these points before signing:
- Text messaging is not appropriate for life-threatening emergencies.
- You agree to avoid sending personal information to the County by text.
- You are responsible for protecting your cell phone or other means of access to text messaging.
- You agree to avoid using your employer's cell phone to send or receive texts with the County.
The form is not for property tax matters or any tax purpose.
When to file Text Message Consent form – Multnomah County
Complete and sign the form before your first visit: the County's New Client Forms page asks new clients to complete and sign its forms, including the Text Message Consent form, before that visit. The form prints no separate due date.
After you sign, two written notices apply under the form's conditions. You inform Multnomah County in writing if your cell phone number changes, and you notify the County in writing when you no longer want to receive text messages from it. The form does not set a validity period or renewal date, and it says the County may impose other conditions on text messaging in the future.
How to fill out Text Message Consent form – Multnomah County
Open the form and check its title
Confirm you have the CLIENT TEXT MESSAGING CONSENT FORM, revision BHD 05.01.22, the version listed on the County's New Client Forms page.
Enter the individual's name and DOB
At the top, write the client's name on the Individuals Name line and the date of birth on the DOB line.
Read the risks of text messaging
Review the list under RISK OF USING TEXT MESSAGING, including that texts are not encrypted, may be forwarded or stored, and may be subject to public records requests.
Read the conditions for use
Review CONDITIONS FOR THE USE OF TEXT MESSAGING: no life-threatening emergencies, no personal information by text, and written notice of a new cell phone number or of ending texts.
Sign and add date and time
In the Client Acknowledgement and Agreement section, the client or guardian signs on the Client/Guardian Signature line and enters the Date and Time.
Enter email, cell phone and carrier
Fill in the Client/Guardian Email Address, the Client/Guardian Cell Phone Number and the Client/Guardian Cell Phone Carrier.
Complete the BHD staff lines
The last row has BHD Staff Member Name and BHD Program. Enter them if you have the information; otherwise ask the County staff member who gave you the form.
Review and download the completed PDF
Check the name, DOB, signature, date and time and contact details, then download or print the completed PDF from FillingPDF and return it as described under How to submit.
How to submit Text Message Consent form – Multnomah County
The form prints no mailing address, portal or drop-off location, and the County's New Client Forms page gives none for it. That page tells new clients to complete and sign the forms before the first visit, and to contact the County for documents in another language.
- Before your first visit: have the signed form ready for your visit, as the New Client Forms page directs.
- Questions about delivery: contact Multnomah County through the New Client Forms page at https://multco.us/info/new-client-forms to ask how it wants the signed form returned.
- Other languages: the page lists versions of the Text Message Consent form in Simplified Chinese and Korean; for other languages, contact the County.
Do not use the form to send personal information by text: the conditions ask clients to avoid sending personal information to the County by text message. FillingPDF lets you fill out and download the PDF; submission follows the County's channels described above.
Common mistakes to avoid
- Leaving the Client/Guardian Signature or the Date and Time blank; the acknowledgement and agreement takes effect only when it is signed.
- Skipping the Client/Guardian Cell Phone Carrier line while filling in the email address and cell phone number beside it.
- Treating text messaging as a way to reach the County in a life-threatening emergency; the form says it is not appropriate for those situations.
- Sending personal information to Multnomah County by text; the conditions tell clients to avoid it.
- Changing your cell phone number without informing the County in writing, as the form requires.
- Stopping text messages informally instead of notifying Multnomah County in writing that you no longer want them.
- Using your employer's cell phone to send or receive texts with the County, which the form asks clients to avoid.
- Mistaking this client consent form for a Multnomah County property tax document; it has nothing to do with tax.
Frequently asked questions
What is the Multnomah County Text Message Consent form?
It is a client form in which you acknowledge the risks of text messaging and agree to the conditions for texting with Multnomah County. It is titled CLIENT TEXT MESSAGING CONSENT FORM, carries the code BHD 05.01.22 and is listed among the County's new client forms.
Is this a Multnomah County property tax form?
No. Despite the county name, it is a consent form for text messaging between a client and Multnomah County, with BHD staff lines at the bottom. It contains nothing about property tax, so use the County's tax pages for property tax questions.
Who signs the Text Message Consent form?
The client or the client's guardian signs on the Client/Guardian Signature line and adds the date and time. The form also asks for the client or guardian's email address, cell phone number and cell phone carrier.
Can I use text messaging in an emergency?
No. The form states that text messaging is not appropriate for life-threatening emergency situations. Do not rely on texts to reach the County in an emergency.
Can I send personal information to the County by text?
The form says clients must avoid sending any personal information to Multnomah County by text. It also says Behavioral Health staff must not send Protected Health Information by text message.
How do I stop receiving text messages from Multnomah County?
Notify Multnomah County in writing that you no longer want to receive text messages. The form also requires you to inform the County in writing whenever your cell phone number changes.
When do I need to complete this form?
Before your first visit. The County's New Client Forms page asks you to complete and sign its forms, including this one, before the first visit. The form itself prints no other deadline.
Is the form available in other languages?
The County's page lists a Simplified Chinese version (短信同意书) and a Korean version (문자메시지 수신 동의) of the Text Message Consent form. For documents in another language, the page tells you to contact the County.
Can I fill out the Text Message Consent form on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, is not affiliated with Multnomah County and does not submit the form; you return it through the County's channels.
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