Opt - In Form

At Rooted Therapy Center, we offer SMS communication to help you stay updated about appointments, clinic hours, and general information. By signing this form, you consent to receive text messages from us. These messages will not include sensitive personal health information and are compliant with HIPAA guidelines.

Full Name *

Phone *

Preferred Contact Method

Phone Call

Text Message

Consent Confirmation - (all sections must be completed) *

I agree to receive text messages from Rooted Therapy Center.

I understand that I can Opt - Out through an opt-out button on website or replying STOP at any time

I understand that SMS messages may include appointment reminders, scheduling updates, and clinic announcements.

Signature

Clear

Date