Email and Text Consent

Our office offers a few different ways to remind our patients of their upcoming dental appointments. We offer a courtesy text, email, or phone call. We ask that you please provide us with the following information if you would like to participate in this service. (Personal contact information is never shared)

Text or Email

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Please list below other family members whose appointments you would like confirmed to this cell phone and/or email address:

Signature

First

Last

Date