Bellevue Dentistry (BDC) Website

First Name*

Last Name*

Email*

example@example.com

Phone Number

Are you an existing patient?*

YesNo

Date of Birth*

Date

How can we help you?*

Existing patient

How can we help?*

New Patient

Do you have insurance?*

YesNo

Message

Terms & Conditions

1. SMS Messaging Service: By providing your phone number, you consent to receive SMS messages, including updates, promotions, and other relevant content.

2. Message Frequency: You may receive approximately 6 messages per month.

3. Message and Data Rates: Message and data rates may apply based on your mobile carrier’s terms.

4. Privacy Policy: Your information will be handled in accordance with our Privacy Policy, which can be viewed at https://bellevuedentistry.com/privacy-policy/

5. Opt-Out Instructions: You can opt out at any time by replying “STOP” to any SMS message. You may also contact us directly at [Insert Contact Information].

6. Liability: We are not responsible for any charges, errors, or delays in SMS delivery caused by your carrier or third-party service providers.

By opting in, you confirm that you are the owner or authorized user of the phone number provided and that you are at least 18 years old.

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