Patient SMS Communication Consent Form

SMS Consent Authorization

By providing my mobile phone number and signing below, I consent to receive appointment-related text messages from the above-named dental practice via Filld, a HIPAA-compliant scheduling platform. I understand the following:

• •Message Types: I will receive text messages only about appointment availability, scheduling confirmations, and related notifications.
• •Message Frequency: Message frequency varies based on appointment availability. I may receive up to 5 messages per month.
• •Message & Data Rates: Standard message and data rates may apply depending on my mobile carrier and plan.
• •Opt-Out: I may opt out at any time by replying STOP to any message. I will receive a confirmation and no further messages will be sent.
• •Help: I may reply HELP to any message for assistance, or contact info@filld.io.
• •No Marketing: I will not receive any promotional or marketing messages. Messages are strictly limited to appointment-related communications.
• •Voluntary: This consent is voluntary and not a condition of receiving dental care. I may decline without affecting my treatment.
• •Privacy: My mobile number will not be sold, shared with third parties, or used for marketing purposes. No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. Full privacy policy available at filld.io/privacy.
• •Carriers: Compatible with all major US carriers. Carriers including T-Mobile are not liable for delayed or undelivered messages.