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Text Consent Form

Due to the changing world of healthcare and technology, Brighter Smile has the ability to provide our patients with certain types of information via-email and/or text messaging. If you wish to have the opportunity to receive information of this type, please complete the form below. Brighter Smile believes strongly in protecting the privacy of our patients. When you provide the information to us, it is only used as a way to communicate with you. In order to protect your privacy, no confidential or personal information will be sent from Brighter Smile via email or text messaging. Brighter Smile does not share the names, e-mail and or telephone numbers of patients with any other company, or with any other patient.
I
consent to communicate via email and/or text
Date(Required)