Gedeon Medical Center
SMS Communication Consent Form

Patient Name:

Date of Birth:

Mobile Number:

I consent to receive SMS text messages from Gedeon Medical Center to the phone number I have provided via the use of an automated messaging system regarding my healthcare, including:

Appointment reminders
Insurance information
Co-payment information
Test results
Referral, order, prescription notifications
Practice updates

Message frequency varies (typically 2-4/month). Standard messaging rates apply.

By checking this box, I agree to receive Text messages about regarding appointment reminders; insurance information; co-payment information; test results; referral, order, prescription notifications; practice updates from Gedeon Medical Center at the phone number provided above. You can reply STOP at any time to opt out. The SMS message frequency may vary. Data rates may apply. Text HELP to 954-842-4285 for assistance. Reply STOP to opt out of receiving SMS messages from Gedeon Medical Center. You will then receive no further SMS communication. For more information, please refer to our privacy policy at Privacy Policy

Signature (Type Full Name):

Gedeon Medical Center SMS Communication Consent Form

Gedeon Medical Center
SMS Communication Consent Form