TEXT MESSAGING SERVICE AGREEMENT

Patient Focused Neurology offers an optional SMS messaging service to help you manage your care. By enrolling, you agree to receive text messages regarding:

  • Appointment confirmations and reminders
  • Pre-visit instructions and check-in notices
  • Insurance and demographic requests
  • Billing and payment reminders
  • Follow-up care or missed appointments

Consent & Privacy: We will not send you text messages without your explicit consent. Your mobile number and SMS consent will not be shared with any third parties or affiliates for marketing purposes. Messages are not encrypted, and anyone with access to your phone or mobile service may be able to view them.

Message Frequency & Fees: Message frequency may vary depending on your care needs. You may receive up to 2–4 messages per week. Message and data rates may apply based on your mobile plan.

Your response has been recorded

I consent to receive text messages from PFN. I understand this is optional and that I can reply STOP at any time to unsubscribe.


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Patient's Name (last, first):
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Patient's date of birth:
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Mobile number 1: (XXX-XXX-XXXX)
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Mobile number 2: (XXX-XXX-XXXX)
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By signing the box below, you consent to receive SMS messages from Patient Focused Neurology regarding appointment reminders and confirmations, insurance information requests, billing reminders, missed appointment follow-ups, and insurance inactivity.

You may opt out at any time by replying “STOP.” Message and data rates may apply. Message frequency may vary. For assistance, text HELP to 805-579-9990. For more information, please review our Privacy Policy at www.pfneurology.com/privacy-policy.



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Date of signing
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