New Connections

Text Communication Consent Form

New Connections Inc. · (559) 248-1548

This form is optional. Consenting to receive text messages is not required to receive treatment, services, or to complete intake — you may decline and still receive all care.

Mobile phone number

Text Alert Service Description. By providing your mobile phone number and checking the optional box below, you agree to receive text messages from New Connections about your appointments and care, such as appointment reminders and requests to reschedule.

Message Frequency. Message frequency varies based on your appointments and care needs.

Standard Rates. Message and data rates may apply depending on your mobile carrier and plan.

Help & Stop. Reply HELP for help or STOP to cancel at any time.

Terms & Privacy. See our SMS Terms at newconnections.org/terms and Privacy Policy at newconnections.org/privacy. We do not sell or share your mobile number or opt-in data with third parties.

(Optional) I consent to receive text messages from New Connections as described above. I understand that consent is not required to receive treatment or services, that this box is voluntary and left unchecked by default, and that I can opt out at any time by replying STOP.

Client signature

Date

For office use only: Form completed on __________ by staff member __________