By signing below, I authorize Trecartin Family Dentistry to contact me by automated and non-
automated SMS text messaging. I understand that message/data rates may apply to messages sent
by Trecartin Family Dentistry under my cell phone plan.
I know that I am under no obligation to authorize Trecartin Family Dentistry to send me text
messages. I may opt-out of receiving these communications at any time by notifying the front desk
Information included in the text messages may include your first name, date/time of appointments,
financial information and/or treatment information. I understand that text messaging is not a
secure form of communication. There is some risk that individually identifiable health information
or other sensitive/confidential information contained in such text may be misdirected, disclosed to,
and/or intercepted by unauthorized third parties. I will notify the office immediately if I am no
longer the owner or authorized user of the mobile number identified.
By signing below, I indicate that I am the primary user for the mobile phone number listed above. I
accept the risk explained above and consent to receive text messages from Trecartin Family
Dentistry to the phone number that I have provided.
Additional family members that can use this number as well are as follows: