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Home›Legal & Policies›SMS Consent: In-Person Patient Intake Form

Legal & policies

SMS Consent: In-Person Patient Intake Form

The SMS consent section presented to patients on the electronic intake form completed at Maxwell Massage PLLC in Seattle.

Document details

Last updatedAugust 6, 2026

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The following is the SMS consent section presented to patients on the electronic intake form completed at our clinic. The consent field is unchecked by default and optional.

Screenshot of the Maxwell Massage PLLC electronic patient intake form showing the SMS consent section with an unchecked consent checkbox and full disclosure text

Disclosure Text (as it appears on the intake form)

By checking this box and providing your mobile phone number, you agree to receive recurring SMS messages from Maxwell Massage PLLC related to appointment reminders, scheduling, and customer care. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. View our Privacy Policy: https://www.maxwell-massage.com/legal/privacy-policy/. Consent is not a condition of service.

The complete intake form is available for reference: Maxwell Massage PLLC Patient Intake Form (PDF). The SMS consent section appears on page 4.

SMS program terms and the current public disclosures are published in our Terms & Conditions, Privacy Policy, and Consumer Health Data Privacy Policy. The intake-form consent remains optional and unchecked by default.

Maxwell Massage PLLC

100 Wall St
Seattle, WA 98121

Tel
(206) 448-9407
Text
(206) 448-9407
Fax
(206) 299-9462
Email
info@maxwell-massage.com
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