Text and Email Consent Form Please complete this form as accurately as possible. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client Name *FirstLastMobile Number *Email *Signature * Clear Signature Date *I CONSENT to the practice contacting me by:Text MessageEmailI will ensure that I keep the practice informed of my up-to-date mobile number and email at all times, and I will notify the practice if the number is no longer in my possession. I DECLINE to the practice contacting me by SMS text and email.AgreeWebsiteSubmit
