Peak Physical Therapy
SMS Communication Consent Form
Date: ____________________
Customer Information:
- Full Name: ______________________________________
- Phone Number (to receive SMS): ___________________________
- Email Address (optional): _________________________________
Consent to Receive SMS Messages:
By signing below, I agree to receive SMS messages from Peak Physical Therapy for the following purposes:
- Appointment reminders
- Follow-up messages
- Billing inquiries
- Promotions or offers (if applicable)
I understand that message frequency may vary depending on the type of communication. I also acknowledge that standard message and data rates may apply based on my carrier’s pricing plan.
Opt-In Agreement:
[ ]By checking this box, I consent to receive SMS from Peak Physical Therapy. Reply STOP to opt-out; Reply HELP for support; Message & data rates may apply; Messaging frequency may vary. Visit Privacy Policy/SMS Terms for our Terms of Service.”