SMS Text Message Consent

SMS Text Message Consent

Authorize Neptune Adult Medicine to send you SMS text message updates and reminders. Please provide your information and agreement below.
Full Name

First NameLast Name
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
By providing my mobile phone number and signing below, I consent to receiving text messages from Neptune Adult Medicine regarding:
• Appointment reminders
• Billing notifications
• Payment requests and confirmations
• Account-related communications
• Other healthcare administrative communication

Message Frequency:
Message frequency varies depending on your interactions with our practice and appointment schedule.

Message and Data Rates:
Message and data rates may apply according to your mobile carrier plan.

Opt-Out Instructions:
You may opt out of receiving text messages at any time by replying STOP to any message. After opting out,
you will no longer receive text messages unless you provide new consent.

Help Instructions:
Reply HELP for assistance or contact our office at (732) 807-3834.

Privacy Policy and Terms of Service:
https://www.cartnickmd.com/the-practice
Patient Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: