Is an electronic signature valid?

Yes. Electronic signatures are legally valid under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are demonstrated.

Generally no for a consent-to-contact form. Notarization is only required where state law or a related document explicitly mandates it; verify for specific transactions.

How can a signer revoke consent?

Provide a clear method in the form; process revocations on receipt and retain documentation of the revocation and its date for audit purposes.

What proof do I need to retain?

Keep the signed record plus the audit trail showing timestamp, IP address, and any authentication used; these elements support attribution and intent evidence.

Are special disclosures required?

For consumer-facing electronic records, ESIGN requires a consumer disclosure about consent to electronic records and a demonstration that the consumer can access the record (15 U.S.C. §7001).

How long should I keep consents?

Retain consents for the active term plus applicable regulatory periods (e.g., IRS 3 years; HIPAA 6 years for healthcare records); consult counsel for industry-specific guidance.

Electronic Signature
Templates
Healthcare
California Consent for Contact

California Consent for Contact

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

CONSENT FOR CONTACT

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

PART A. To be completed by person signing consent

PART B. To be completed by a representative of CDSS or a CA licensed adoption agency. If Part B or C is completed, do not complete Part D.

PART C. Check if applicable. Notarized signature has been previously submitted to CDSS or a CA licensed adoption agency.

PART D. To be completed by a Notary Public ONLY IF Part B or C is not completed.

1. Please complete both sides of this form.

2. This form must be witnessed by either a representative of the California Department of Social Services (CDSS) or a California (CA) adoption agency licensed by CDSS, or notarized by a Notary Public.* If the signing of this form is witnessed by a CDSS or adoption agency representative, photo identification of the person signing must be obtained and noted on this form. THIS FORM WILL BE RETURNED TO YOU IF IT IS NOT WITNESSED OR NOTARIZED

BIRTH PARENT: By signing this form, I voluntarily give my consent to the CDSS or licensed adoption agency to disclose my name and address to my adult biological child who was adopted so he/she may contact me.

ADULT ADOPTEE: By signing this form, I voluntarily give my consent to the CDSS or licensed adoption agency to disclose my name and address to my birth parent(s) so he/she may contact me.

I understand that the CDSS does not provide search services to locate birth parents or adoptees and that these parties must contact CDSS or the licensed adoption agency to request a Consent for Contact (AD 904) form.

I understand that the birth parent(s) and the adoptee must sign a consent before CDSS or the licensed adoption agency may disclose identifying information and that signing this consent does not necessarily ensure that a contact will be made pursuant to Family Code Section 9204.

I understand that the law prohibits CDSS or the licensed adoption agency from soliciting, directly or indirectly, the execution of such a consent.

I understand that I should keep the CDSS or the licensed adoption agency informed of my current name and address.

I understand I have the right to rescind this consent at any time by notifying CDSS or the licensed adoption agency in writing.

Distribution Instructions:

Original: Agency/Department

Copy: Person Signing

DESIGNATE ONE:

I am the

Birth Parent Adult Adoptee (age 18 or older)

NAME (PLEASE PRINT) OTHER NAME(S) BY WHICH I HAVE BEEN KNOWN

STREET ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER

SIGNATURE DATE

PART B. To be completed by a representative of CDSS or a CA licensed adoption agency. If Part B or C is completed, do not complete Part D.

SIGNATURE OF CDSS/ADOPTION AGENCY REPRESENTATIVE

AGENCY/DEPARTMENT NAME

IDENTIFICATION OF BIRTH PARENT/ADULT ADOPTEE (SPECIFY, I.E., DRIVER’S LICENSE, PASSPORT, ETC.)

ADDRESS DATE TELEPHONE NUMBER

Part C. Check if applicable. Notarized signature has been previously submitted to CDSS or a CA licensed adoption agency.

PART D. To be completed by a Notary Public ONLY IF Part B or C is not completed.

***COMPLETED BY Notary Public***

The Notary Public must staple the Acknowledgement document to this form and sign and date below.

SIGNATURE OF NOTARY

DATE

Definition of Notary Public: A Notary Public is a public officer authorized by law to certify documents and to confirm your identity. Notaries may be located at most banks and credit unions or listed in the yellow pages of your local phone directory.

In order to locate the correct adoption file, please assist us by completing the information below. If you do not know this information, please write “unknown”.

Adoptees: Please check the box if you also want to receive nonidentifying background information about your birth parents.

Birth Parents: Please check the box if you also want to receive nonidentifying information about the family that adopted your child.

Refer to Family Code Sections 8706; 8817 for a full description of nonidentifying information.

What Happens to the Consent

The consent may be sent directly to the adoption agency which handled the adoption, if known, or to the Department’s Central Office: Adoptions Support Unit, Department of Social Services, 744 P Street, M.S. 8-12-31, Sacramento, CA 95814. If the adoption was an independent (private) adoption, the consent will be acknowledged and placed in the adoption file and you will be sent any available information you requested. If the adoption was an agency adoption, the consent will be returned to you with the name and address of the correct agency so you may send it directly to that agency.

AD 904 (7/11)

What the California Consent for Contact is and when it matters

The California Consent for Contact documents a person's agreement to receive communications (phone calls, text messages, email) related to a specific purpose such as service updates, account notices, or marketing outreach. It records the consenting party, the scope and methods of permitted contact, the effective date, and any limitations or opt-out instructions. Where consumer-facing, the form must also satisfy electronic consent rules under the federal ESIGN Act (15 U.S.C. ch. 96) and California privacy and consumer-protection requirements. Properly completed, it creates auditable evidence of permission to contact.

Why a clear consent form reduces legal and operational friction

A concise California Consent for Contact clarifies expectations, reduces disputes about communication authorization, and documents consent so businesses can demonstrate compliance with ESIGN and state privacy rules. It also standardizes opt-out procedures and retention practices, lowering risk during audits or regulatory inquiries.

Step-by-step: completing a California Consent for Contact

Follow these sequential steps to collect clear, enforceable consent and to maintain records supporting electronic execution.

01

Prepare the form: List contact methods, purpose, and opt-out language before sending.
02

Collect identity details: Record full legal name and contact information exactly as provided.
03

Capture consent: Obtain signature or a verifiable electronic acceptance with intent to sign.
04

Store evidence: Save the signed record and audit trail for required retention periods.

Configuring an online workflow for collection and tracking

Design the digital workflow to minimize signer friction while preserving required audit data and consent disclosures.

Field	Configuration
Consent disclosure	Present ESIGN consumer disclosure before signature
Authentication	Use email link or SMS code; add KBA for higher assurance
Audit trail	Capture IP, timestamp, device type, and signer action
Storage	Save PDF and signed metadata in secure archive

Technical and platform requirements for electronic collection

Ensure the signing platform supports audit trails, secure storage, and flexible authentication to meet legal and operational needs.

Integrations: Connect to CRM and cloud storage for record synchronization
File types: Accept PDF and DOCX uploads for consistent rendering
Security: Use TLS and AES encryption in transit and at rest

Choose platform settings that retain machine-readable audit logs and allow export of signed copies for compliance reviews.

Typical electronic consent collection flow

A standard e-consent flow balances user experience with verifiable records to demonstrate intent, attribution, and retention ability.

Upload form: Sender uploads the consent form to the signing platform
Place fields: Add signature, date, and consent-disclosure fields
Authenticate signer: Signer confirms via email link or SMS code
Capture audit trail: Platform records timestamp, IP, and actions

Common users and scenarios for consent forms

The California Consent for Contact is used across operations where documented permission to communicate is legally or operationally required.

Customer support and account teams documenting permission to send billing texts and email updates.
Healthcare administrators obtaining authorization for appointment reminders within HIPAA constraints.
Sales and marketing teams confirming explicit consent for promotional outreach to California residents.

Tailor the form fields and disclosure language to the controlling legal standard (consumer-facing vs. business-to-business) and retention requirements.

Essential components of a professional consent form

A complete California Consent for Contact balances clarity, scope, authentication, and recordkeeping to support compliance and enforcement.

Clear purpose

State the precise reason for contact (billing, service notices, marketing) so consent is narrowly scoped and auditable.

Method specification

List permitted channels (SMS, phone, email) and identify the exact phone number or email address covered by the consent.

Opt-out terms

Provide explicit, easy-to-follow withdrawal procedures and state any processing delay for opt-out requests.

Effective date

Record the date consent begins and whether it renews automatically or expires after a set period.

Authentication

Capture signer identity through email verification, SMS code, KBA, or stronger methods when required.

Retention note

State where the signed record will be stored and include a reference to the applicable retention period.

Security and compliance checkpoints to include

Encryption: TLS 1.2/1.3; AES-256

Audit trail: IP, timestamp, action log

HIPAA support: BAA available if required

Retention controls: Controlled, exportable archives

Access controls: SSO and role-based permissions

Certifications: SOC 2 Type II, ISO 27001

Timing considerations and responsiveness expectations

Maintain clear internal deadlines for processing consents, handling opt-outs, and responding to revocation requests to reduce compliance risk.

Opt-out processing timeframe:

Acknowledge and implement opt-out within a defined business period, typically 24–72 hours

Revocation handling:

Treat revocations as effective on receipt unless a short operational delay is disclosed

Record retention start:

Retention begins on the effective date of consent

Audit readiness:

Prepare signed records and audit logs within 5 business days for internal or regulator review

Periodic review:

Review consent records annually to confirm continued relevance and legality

Key milestones from issuance to archival

Track consent lifecycle across discrete stages to ensure proper capture, use, and disposition of contact permissions.

01

Issue consent form

Deliver the disclosure and request consent with clear purpose and scope

02

Collect signature

Obtain a verifiable signature and capture the audit trail

03

Use for permitted contact

Apply consent only for the stated channels and purposes

04

Revoke and archive

Process revocations and move the record to long-term archive per retention policy

Common mistakes to avoid when preparing consent records

Using vague purpose language that fails to limit the types of permitted communications.
Failing to capture or retain the electronic audit trail proving signer intent and attribution.
Collecting consent without providing a clear opt-out mechanism and processing timeline.
Mismatching signer names or contact details between identification and the consent record.

Principal legal and operational risks of deficient consent

Regulatory enforcement: Potential investigations and administrative penalties under state consumer-protection laws

Private litigation: Exposure to private claims, including statutory damages in communication-specific statutes

Business interruption: Operational disruption when communications must be paused pending remediation

Reputational harm: Customer trust erosion from unwanted or noncompliant outreach

Financial cost: Remediation, legal, and customer-notification expenses

Loss of evidence: Insufficient records reduce ability to defend consent in audits or litigation

Real-world examples of consent use and outcomes

These short examples illustrate practical uses and how proper documentation prevents disputes.

Medical appointment reminders

A clinic requests consent for SMS reminders at intake

Consent includes phone number and opt-out steps
Proper records prevented a billing dispute after a patient withdrew consent, showing timely opt-out processing and preserved audit logs.

Property showing notifications

An agent collects consent to send listing updates via email

Consent specifies email address and marketing flag
Clear scope avoided claims of unsolicited marketing and streamlined unsubscribes.

Practical tips to keep consent defensible and usable

Adopt straightforward language, precise scope, and reliable storage to reduce ambiguity and administrative burden.

Be specific

Use narrow purpose statements and list exact contact channels to avoid overbroad consent claims and enhance defensibility.

Document consent method

Record how consent was obtained (email link, SMS opt-in, signed form) and preserve the proof in an audit trail.

Allow easy opt-out

Provide simple, prominently displayed instructions for withdrawal and document the date and time of revocation.

Review periodically

Reconfirm or refresh consent for long-term relationships and purge records per your retention policy when appropriate.

Sample vendor pricing and compliance snapshot for eSignature platforms

Compare baseline pricing and common compliance features across providers; signNow is listed first per comparative format requirements.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no credit card required	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions about California Consent for Contact

Answers to common questions about validity, revocation, electronic signatures, and recordkeeping for consent forms in California.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are legally valid under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are demonstrated.
Do I need a notary?
Generally no for a consent-to-contact form. Notarization is only required where state law or a related document explicitly mandates it; verify for specific transactions.
How can a signer revoke consent?
Provide a clear method in the form; process revocations on receipt and retain documentation of the revocation and its date for audit purposes.
What proof do I need to retain?
Keep the signed record plus the audit trail showing timestamp, IP address, and any authentication used; these elements support attribution and intent evidence.
Are special disclosures required?
For consumer-facing electronic records, ESIGN requires a consumer disclosure about consent to electronic records and a demonstration that the consumer can access the record (15 U.S.C. §7001).
How long should I keep consents?
Retain consents for the active term plus applicable regulatory periods (e.g., IRS 3 years; HIPAA 6 years for healthcare records); consult counsel for industry-specific guidance.

Explore Templates

Missouri Last Will and Testament Stock Certificate US Tax Court Memorandum 2017 Minnesota Contract for Deed Recent Developments in Georgia Fiduciary Law Servicemembers Civil Relief Act (SCRA)

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now