First-Time Visit? Enjoy a FREE First Exam & Consultation – New Clients Only! *Terms Apply Text and Email Consent Form Please complete this form as accurately as possible. Please enable JavaScript in your browser to complete this form.Client Name *FirstLastMobile Number *Email *Signature * Clear Signature Date *I CONSENT to the practice contacting me by:Text MessageEmailI will ensure that I keep the practice informed of my up-to-date mobile number and email at all times, and I will notify the practice if the number is no longer in my possession. I DECLINE to the practice contacting me by SMS text and email.AgreeCommentSubmit
