Vitality Weight Loss

Text Messaging Consent Form

Purpose:
Vitality Weight Loss uses text (SMS) messaging to communicate appointment reminders, program updates, motivational messages, and important information about your care. Text messaging is a convenient way for us to stay in touch, but it does have some privacy limitations.

Consent to Receive Text Messages

By signing below, you consent to receive text messages from Vitality Weight Loss at the mobile phone number you provide. These messages may include:

• Appointment reminders, schedule confirmations, and cancellations
• Health-related tips, motivation, and progress check-ins
• Program announcements or follow-up instructions from your care team
• Administrative or billing notifications

Message Frequency: Typically 1–4 messages per week, depending on your program participation and communication preferences.
Message & Data Rates: Standard message and data rates may apply based on your carrier plan.

Privacy Notice

Text messaging is not a fully secure form of communication. Although Vitality Weight Loss limits the information shared by text, messages may still contain identifiable information (e.g., your name, appointment time). By consenting, you acknowledge and accept this potential risk.

We will not send confidential medical information or test results by text message. You may revoke your consent at any time by replying STOP to any text or by notifying our office in writing.

Your Consent

• I consent to receive text messages from Vitality Weight Loss at the mobile number listed below.
• I understand that text messaging is not a secure means of communication.
• I understand that message and data rates may apply.
• I understand that I may revoke this consent at any time.