Consent to Receive Text Messages Adult Client or Parent/Guardian
By consenting to receive SMS messages, you are agreeing to be contacted by NOVA Allergy Group on behalf of your healthcare providers via text (SMS) messages to your mobile
phone and other wireless devices, and the use of an automatic telephone dialing
system, artificial voice, and prerecorded messages, for the purpose of providing
appointment services. Messages may include appointment reminders, scheduling updates, and important health-related notifications from your provider.
Thank you for opting in to receive messages from NOVA Allergy Group. Msg frequency varies. Msg & data rates may apply. Reply HELP for help. Reply STOP to opt-out.
For more information, please read our www.allergyofnova.com/privacy-policy and www.allergyofnova.com/sms-texting-services-terms-and-conditions/
Message frequency varies based on appointment needs and healthcare updates.
We will not share, sell, or use your opt-in contact information for marketing or third-party purposes.
Message and data rates may apply based on your carrier.
You may opt-out of receiving text (SMS) messages at any time by replying with the word
STOP from the mobile device receiving the messages. NOVA Allergy Group will not share,
sell or use your contact information for other purposes. The message will read “You have successfully opted out of messages from NOVA Allergy Group. You will receive no further messages.”
Thank you for reaching out to NOVA Allergy Group. Please call us at (703) 327-3300 or visit www.allergyofnova.com for support. Reply STOP to opt-out.
___ YES, email notifications only
___ YES, email and text (SMS) message notifications
___ YES, voice notifications only
___ YES, email, text (SMS) message, and voice message notifications
Phone Number: ______________________________
Email: _________________________________________
Print name of Adult Client or Parent’s/Guardian of Child Client. Date of Birth
Print Client or Parent/Guardian Name to rep
Date of Birth