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By checking this box, I consent to receive messages from Upper Valley Urgent Care related to the records of treatments I have requested. These messages may include appointment reminders, confirmations, and notifications among others. Message frequency may vary. Message & Data rates may apply. Reply STOP to opt-out. See our Privacy Policy.

I hereby authorize the release of the results of this questionnaire/assessments to Upper Valley Urgent Care for the purpose of clinical evaluation, diagnosis, and coordination of care. I understand that this information will be used by my healthcare provider to better understand my mental health status and to support treatment planning. I understand that this questionnaire/assessment is a standardized tool to assess the severity of depressive symptoms. My responses and results will be kept confidential and used solely for clinical purposes. I understand that I have the right to revoke this consent at any time by submitting a written request, except to the extent that action has already been taken based on this authorization.

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