By supplying my home phone number, mobile phone number, email address, and any other personal contact information, I authorize my health care provider to employ a third-party automated outreach and messaging system to use my personal information, the name of my care provider, the time and place of my scheduled appointment(s), and other limited information, for the purpose of notifying me of a pending or missed appointment.

I understand that notifications may be repeated multiple times per appointment and may exceed contacts more than three times per week. There is some level of risk that information in regular, unencrypted text or email could be read by someone besides you and, as a result, I also authorize my healthcare provider to disclose to third parties, who may intercept these messages, notification of a pending or missed appointment.