Paper SMS consent form (sample)

    Patients can also sign up on this optional paper form at the front desk. Staff record the signed form in our system under their own login, and the form is scanned into the patient's medical record. When we record the form, we attempt to send a confirmation text from (786) 905-0041 to that number, unless it is already signed up for our texts.

    English formSpanish form

    I agree to receive SMS appointment reminders, confirmations, and two-way customer care messages from AnaWell Care about scheduling, callback requests, and clinic administrative questions at the mobile number I provide. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Consent is optional and is not a condition of receiving care. We will not sell or share mobile information with third parties for promotional or marketing purposes.

    Privacy PolicySMS Terms