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Consent To receive text message and electronic communication alerts

We have the ability to send text and email messages to your provided cell phone number to receive account information such as appointment reminders, appointment openings, account updates, marketing specials, opportunities, and other alerts

Please indicate below whether you would like to receive text and email confirmation,reminders,newsletters,specials, and other updates. Text message charges from your cell phone provider may apply.

By signing below, I wish to enroll in the text message and email alert communication explained above

Name:

Cell Phone:

Email Address:

Signature of Patient:

Date:

You can withdraw your consent at any time by calling the office. You are resposible providing updates to your cell phone and email information

It is important to note that text communication is not always secure. Text messages can be intercepted and for this reason, we do not communicate personal health information through this method.