Consent To Receive Text Message Appointment Reminders

Your health is important to us and in order to provide you with the best possible care, we can send text reminders for upcoming appointments. By signing below, I authorize Family First Chiropractic Clinic PLLC and its affiliates to contact me by text message for appointment reminders. I understand that message/data rates may apply to messages sent by Family First Chiropractic Clinic PLLC or its affiliates under my cell phone plan. I know that I am under no obligation to authorize Family First Chiropractic Clinic or its affiliates to send me text messages. I may opt-out of receiving these communications at any time by call the front desk at 641-954-8598 or by responding STOP to the text line. I understand that text messaging is not a secure format of communication. There is some risk that individual identifiable health information or other sensitive or confidential personal health information contained in such text may be misdirected, disclosed to or intercepted by unauthorized third parties. Information included in text messages may include your first name, date/time of appointments, name of chiropractor, and clinic phone number, or other pertinent information. By signing below, I indicate I am the primary user for the mobile phone number listed, I accept the risk explained above and consent to receive text messages from Family First Chiropractic Clinic and its affiliates to the phone number that I have provided. We are currently using OpenPhone and the number is (641) 244-3399.

Patient Name ________________________________ Phone Number _____________________

Patient Signature _____________________________ Date _____________________________