SMS Consent Form

By checking the box below, you (the Client) consent to receive text messages from KidsConnect Pediatric Therapy related to basic communication (ex. scheduling, directions, parking info, etc.).

You can reply 'STOP' at any time to opt-out. Messages and data rates may apply. Message frequency may vary.

Text 'HELP' to (708) 763-9582 for assistance or visit our website at kidsconnect.care. We do not share or sell SMS opt-in, or phone numbers for the purpose of SMS messaging. For more information, please refer to our Privacy Policy at kidsconnect.care/privacy-policy, and Terms and Conditions at kidsconnect.care/terms .

Name

First Name

Last Name

Phone

(###)

###

####

Date

MM

DD

YYYY

I hereby acknowledge that I have read and understood the above conditions.