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How patients opt in to texting
Text Message Consent Form
This is the consent form patients complete and sign in person at our front desk
(119 N Shelby St, Cadillac, MI) before receiving any text messages from us. The checkbox
is never pre-checked — each patient makes their own choice, and declining never
affects care.
☐Yes, I would like to
receive text messages from Active Chiropractic of Cadillac at the mobile number
below, including appointment reminders, appointment confirmations, feedback requests, and
occasional practice updates (such as office closures).
Message frequency varies; typically 1–8 messages per month.
Message and data rates may apply. I can reply
STOP at any time to opt out of all messages, or
reply HELP for help. Consent is not a condition of
receiving care, and declining or opting out does not affect my treatment in any way.
SMS Privacy Policy: activecadillac.com/sms-privacy.html
SMS Terms & Conditions: activecadillac.com/sms-terms.html
Mobile number: (________) ________ – ____________
Patient name (print)
Signature
Date
Questions about our texting program? Call or text
(231) 468‑3777.
