SMS Opt-In Preview — Bluffline
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SMS opt-in: standalone, optional, and never required for care.

This page shows the standalone SMS consent form used by participating dental practices. The form is presented to patients as a separate, dedicated agreement — never bundled with patient registration, treatment forms, or any other paperwork. SMS consent is always optional and is never required to receive dental care.

This is a preview, not a live form

This page demonstrates the standalone SMS consent form used by participating dental practices. The form is presented to patients as a separate, dedicated agreement — never bundled with patient registration, treatment forms, financial agreements, HIPAA notices, or any other paperwork. SMS consent is always optional and is never required to receive dental care. This preview is published so reviewers, practices, and patients can verify the consent experience is voluntary, unbundled, and standalone.

Participating practice — example

Westside Dental — SMS Consent Form

We'd like your permission to send you appointment-related text messages. This consent is optional and is not required to receive dental care.

This is a standalone SMS consent form. It is presented separately from patient registration, treatment authorizations, financial agreements, HIPAA notices, and any other paperwork. Declining SMS does not affect your access to dental care.

SMS Messaging — Optional

Optional — not required for care

Receive appointment reminders and updates by text

If you'd like, we can text you appointment reminders, recall notifications, and scheduling updates. This is completely optional. You'll continue to receive full dental care whether or not you opt in.

Prefer not to receive texts? No problem — leave the box unchecked. You'll still receive the same dental care, and the practice will reach you by phone or email instead.

Your SMS consent is a separate, standalone agreement. You can revoke consent at any time by replying STOP to any message from us, or by contacting the practice directly. See the SMS Messaging Policy for full details.

This is a preview — submissions are not recorded.

How this opt-in is compliant

  • SMS consent is a standalone agreement, separate from registration paperwork, treatment forms, financial agreements, and all other patient documents.
  • Consent is not a condition of receiving healthcare services.
  • The checkbox is unchecked by default and must be affirmatively selected.
  • The opt-in language identifies the sender, message types, frequency, opt-out and HELP instructions, and rate disclaimer.
  • Patients can revoke consent at any time by replying STOP.
  • Patients who decline SMS continue to receive full dental care through phone and email.

Related

SMS Messaging Policy Privacy Policy Terms of Service Contact us with questions

Questions?

If you have any questions about how SMS opt-in works at participating practices, please reach out.

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