This is the consent form used to enroll patients in CareSafe text messaging. Consent is collected in person at the medical practice. There is no public web sign-up form and no online enrollment.
What staff say when collecting consent
"Would you like to get text messages from our office? You can text us with questions and we'll text you back, and we'll confirm appointments that way too. If you'd like that, write your mobile number on this form and sign it — the form explains how many messages to expect, how to stop them, and that it's entirely up to you."
Consent form
- I will receive up to 10 messages per month, plus replies to messages I send.
- Message and data rates may apply.
- I can reply STOP at any time to unsubscribe.
- I can reply HELP for help.
- Text messaging is not secure and must not be used for emergencies. In an emergency I will call 911.
- Consent is not a condition of receiving care, and I may withdraw it at any time.
Confirmation message the patient receives
"You are now opted in to receive messages from your physician's office via CareSafe. Up to 10 msgs/month. Msg & data rates may apply. Reply HELP for help, STOP to unsubscribe."