Please review the following information carefully.
In order to provide you with captioned telephone service, ClearCaptions must first obtain the following from you in writing:
- Certification of Hearing Loss (“Certification”); and
- Consent to include certain personal information in the Telecommunications Relay Service User Registration Database (your “Consent”)
In order to use this electronic system to provide ClearCaptions your Certification and Consent, the law requires that we provide you with the following notifications. By completing the Certification and Consent, you acknowledge receipt of this disclosure, consent to the electronic delivery of these documents, and the use of your electronic signature on each document where such electronic signature will have the same legal effect as one provided in writing.
Your consent to use electronic records and signatures also applies to other documents ClearCaptions provides to you relating either to services or products. You may withdraw your consent to use electronic records and signatures at any time using the procedures described below.
Right to Paper Copies
You have the option to provide your Certification and Consent in paper form. Contact ClearCaptions at 866-868-8695 if you would like to complete a paper Certification and/or Consent form. Even if you consent to use of your electronic Certification and Consent, you may still obtain a paper copy of the electronic Certification and Consent by going to ClearCaptions’ website at clearcaptions.com or by sending an email to firstname.lastname@example.org.
Hardware and Software Requirements
To electronically access and retain documents, such as this Consent, you will need to use a device capable of accessing the internet and use of one of the following web browsers such as Chrome, Internet Explorer, or Firefox.
If you agree to the use of your electronic Certification and Consent, you may later withdraw such consent to have the record available in electronic form (or made available in electronic form) by sending notice of your intent to withdraw consent via email to email@example.com or via facsimile (FAX) transmission to 877-846-9122. If you notify us of your withdrawal of consent, we will provide to you a paper copy of the electronic Certification and Consent record. We also will maintain a paper copy of the record and will ensure that the record is no longer made available nor accessible in any electronic form or manner.
If you agree to use of the electronic Certification and Consent, we advise you keep us informed of any change in your contact information, including your email and physical address. Please send notice of changes to your contact information to: firstname.lastname@example.org or 866-868-8695. When submitting this information, please provide your name, ClearCaptions account number, and your telephone number[s] for which service is provided.
Your Ability to Access the Certification and Consent
By completing and submitting your Certification and Consent, you acknowledge that you can access these documents electronically in the formats designated above.
PLEASE PRINT AND RETAIN A COPY OF THIS AGREEMENT FOR YOUR RECORDS BY GOING TO THE CLEARCAPTIONS WEBSITE AT clearcaptions.com OR REQUEST A COPY THAT CAN BE PRINTED BY SENDING AN EMAIL TO email@example.com.
To download a paper copy of this disclosure, click here.