SMS Consent — In-Person Patient Intake Form

Last Updated: July 6, 2026

The following is the SMS consent section presented to patients on the electronic intake form completed at our clinic. The consent field is unchecked by default and optional.

Screenshot of the Maxwell Massage PLLC electronic patient intake form showing the SMS consent section with an unchecked consent checkbox and full disclosure text

Disclosure Text (as it appears on the intake form)

By checking this box and providing your mobile phone number, you agree to receive recurring SMS messages from Maxwell Massage PLLC related to appointment reminders, scheduling, and customer care. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. View our Privacy Policy: https://www.maxwell-massage.com/legal/privacy-policy/. Consent is not a condition of service.

The complete intake form is available for reference: Maxwell Massage PLLC Patient Intake Form (PDF). The SMS consent section appears on page 4.

SMS program terms are published in our Terms & Conditions.