Confirmation (Mini Concierge) | WellCare NY Concierge Care

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Member Name*

First Last

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Mobile Number*

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Member ID*

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Which Condition track is the Member being enrolled in*

Sleep
Chronic Pain

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Consent*

We’re just about done signing you up. You’re already enrolled, and by agreeing, you’ll also receive additional messages. I need you to confirm that you understand that text, like email, is not considered a secure technology and that the messages you receive may indicate the nature of your condition. However, beyond the general nature of your condition, this program does not send Protected Health Information (PHI) via text. Also, it uses text messages from your text plan but there are absolutely no additional charges. Do you accept?

I have completed the enrollment form, provided electronic consent to enroll the patient in additional tracks, and the patient grants permission to Fidelis Care and GoMo Health to contact their cell phone via text message from the phone number 52046.

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Enrolled by*

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Enrolled by Value

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Enrolled by*

First Last

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Mobile_Found

Thank you for completing the Interest Form on behalf of:

First Name: Patient
Last Name: Patient
Mobile Number: Phone Number

Care messages will begin immediately.

NOTE: This member information has not been found. It’s likely the member is not currently enrolled in Clinical Services. To make them eligible for these tracks, they must first be enrolled in the Clinical Services program.

Thank you!