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Reminder Texts Consent Form - Adult

Jewish Family and Career Services of Atlanta
4549 Chamblee Dunwoody Road
 Client Information
  First Name:  * Last Name:  *  
           
  Date of Birth:  * Birth Sex: 
* 
         
  Address: City:  
  State: Zip Code :  
  Phone No:  
* Date of Service
 
EXPLANATION OF CONSENT FORM:    To ensure that Jewish Family and Career Services provides the best care possible to our clients, we send reminder texts to clients prior to their scheduled appointments. The intent of these texts is to remind clients of pending appointments with our therapists. These texts are made only as a service to clients to ensure they are aware of their appointments with us. These texts are provided at no cost to clients. With this document, JF&CS asks you to authorize us to send you reminder texts prior to your appointment with any of our clinicians. However, your treatment with JF&CS will not be impacted by your decision in this regard. Should you decide not to give us permission to send you reminder texts, your treatment will continue uninterrupted and normally. Further, should you grant JF&CS permission to send you send you reminder texts but change your mind at a later date, you may revoke this permission to stop receiving reminder texts. If this happens, you must communicate this to your therapist or any other member of the clinical or administrative member of the clinic. Upon receipt of your new instructions, we will take all necessary actions to ensure you no longer receive text reminders.
* Consent to Receive Text Reminders
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