CFE Communication Consent Form

Communication Consent Form

Thank you for interest in an eye exam with Cornerstone Family Eyecare. You will be redirected to our online appointment portal after completing the communication consent form.

Patient Name*

First NameMiddle NameLast Name

Mobile Number*

Patient E-mail

example@example.com

Thank you for your interest in an eye exam at Cornerstone Family Eyecare. Please opt-in or opt-out of receiving SMS or Text communication from our office regarding your office visit.*

Yes, I agree to receiving and sending text messages from Cornerstone Family Eyecare.No, I DO NOT agree to receiving communication through text message from Cornerstone Family Eyecare.

By continuing booking, I declare that I, as the person booking, am 18 years or older, am authorized to book on behalf of any person listed in this form, and accept The Optometry Practice SMS Terms & Conditions and Privacy Policy.

Please verify that you are human*

3440 W FM 544 Wylie TX 75098
Phone: 469-405-1779
Text: 626-600-8262