Text Message/Email Communication Consent Email Text and Email Consent CONSENT FOR EMAIL AND/OR TEXT USAGE FOR APPOINTMENT REMINDERS AND OTHER HEALTHCARE COMMUNICATIONS 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. 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 following Cell Phone number. If needing to make appointment changes, please contact the office at 701-483-3899. The practice does not charge for this service, but standard text messaging rates may apply as provided in your wire-less plan (contact your carrier for pricing plans and details. First Name Last Name Cell Phone Number * Email Address * Electronic Caregiver Signature * Date *
