Consent to Send Facsimiles

In accordance with the Federal Communications Commission's Telephone Consumer Protection Act of 1992, MEDRelief Staffing^® must have written authorization from healthcare facilities permitting facsimile (fax) communications. By signing in the space below, the authorized person is providing your healthcare facility's consent to receive information from MEDRelief Staffing^® via fax. MEDRelief Staffing^® does not sell, rent, or share fax information with other organizations.

Please complete the following text boxes online, print the page, sign where requested, and fax or mail this form to MEDRelief Staffing^® .

Thank you for giving your consent to us to fax you with important news and information on a timely, accurate basis.