PATIENT INTAKE FORM

 

Summary Terms & Conditions:
Our mobile text messages are intended for subscribers over the age of 13 and are delivered via USA short code 25101.You may receive up to 2 message(s) per month for 6. Message and data rates may apply. This service is available to persons with text-capable phones subscribing to carriers including AT&T, Verizon Wireless, T-Mobile(r), Sprint, Virgin Mobile USA, Cincinnati Bell, Centennial Wireless, Unicel, U.S. Cellular(r), and Boost. For help, text HELP to 77453, email [EMAIL], or call [CONTACT NUMBER]. You may stop your mobile subscription at any time by text messaging STOP to short code 77453.

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