Consent For Email And Text Messaging-Kids Patients in our practice may be contacted via email and/or text messaging to remind you of an appointment, to obtain feedback on your experience with our healthcare team, and to provide general health reminders/information. If at any time I provide an email or text address at which I may be contacted, I consent to receiving appointment reminders and other healthcare communications/information at that email or text address from the Practice. The practice does not charge for this service, but standard text messaging rates may apply as provided in your wireless plan (Contact your carrier for pricing plans and details). I consent to receive text messages from the practice at my cell phone and any number forwarded or transferred to that number or emails to receive communication as stated above. I understand that this request to receive emails and text messages will apply to all future appointment reminders/feedback/health information unless I request a change in writing. I authorize to receive text messages for appointment reminders, feedback, and general health reminders/information to the primary phone number listed below.Phone Number(Required)I authorize to receive email/text messages for appointment reminders and general health reminders/feedback/ information in the Patient Portal to the following.Email(Required) Print Name of Patient(Required) First Last Date MM slash DD slash YYYY PATIENT/GUARDIAN SIGNATURE(Required)
