SMS consent

Purpose of Text Communications

By signing this form, you authorize Agave Oral Surgery to communicate with you via SMS/text messaging regarding:

• Appointment reminders and confirmations
• Scheduling notifications
• Pre-operative and post-operative instructions
• Prescription and pharmacy notifications
• Billing and insurance matters
• Limited clinical follow-ups related to your care

HIPAA & Privacy Disclosure

Agave Oral Surgery is committed to protecting your Protected Health Information (PHI). However:

• SMS/text messaging is not a fully secure or encrypted method of communication.
• Messages may be transmitted over networks not controlled by our office.
• There is some risk that text messages could be accessed by unauthorized individuals.
• Text messages may contain limited protected health information (e.g., appointment dates, procedure references).

By signing below, you acknowledge and accept these risks and authorize Agave Oral Surgery to communicate with you via text message.

Message Terms

• Message frequency varies based on treatment and appointments.
• Standard message and data rates may apply.
• You may opt out at any time by replying STOP.
• For assistance, reply HELP or call our office at (_) _-.
• Text messaging is not monitored 24/7 and should not be used for emergencies. Call 911 for medical emergencies.