SMS Communication Consent Form

American Institute of Mental Health Inc. uses SMS messages to communicate with patients, parents, legal guardians, authorized caregivers, prospective patients, employees, contractors, and other individuals who have requested or authorized communication. Complete this form to provide or withdraw consent to receive text messages.

Business: American Institute of Mental Health Inc. · Website: americaninstituteofmentalhealth.com · Support: management@americaninstituteofmentalhealth.com · +1 786-652-6945

First name *

Last name *

Mobile telephone number * Email address * Relationship to the organization * Which communications would you like to receive?

Appointment reminders and scheduling Intake and registration updates Insurance or authorization updates Billing and administrative notices Requested documents or forms Office closures and service announcements Employee schedules and shift updates Credentialing, training, and HR notices Customer or employee support Other requested communications

I consent to receive SMS and MMS messages from American Institute of Mental Health Inc. at the mobile number provided. Messages may include appointment reminders, scheduling updates, intake information, insurance or authorization notices, billing or administrative communications, office announcements, employee scheduling, credentialing, training, HR notices, and support messages, depending on my relationship with the organization. Message frequency varies. Message and data rates may apply. Reply STOP to cancel text messages at any time. Reply HELP for assistance or contact management@americaninstituteofmentalhealth.com or +1 786-652-6945. Consent is not a condition of purchasing goods or receiving services. My mobile information will not be sold or shared with third parties for their marketing or promotional purposes. I have reviewed the Privacy Policy and Terms and Conditions.

Privacy Policy · Terms and Conditions

Consent action * I agree to receive SMS/MMS messages I withdraw or decline SMS/MMS consent Full legal name as electronic signature *

Date of consent

Time of consent

Information submitted through this form is used to document and manage SMS communication preferences. Mobile information will not be sold or shared with third parties for their marketing or promotional purposes. Information may be provided to service providers only as necessary to deliver communications and operate the messaging service. Completing this form is not required to receive healthcare services or employment.

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Preference recorded

Thank you. Your SMS communication preference has been recorded. Please save your confirmation number for your records. You may withdraw consent at any time by replying STOP to a message or by contacting American Institute of Mental Health Inc. at management@americaninstituteofmentalhealth.com or +1 786-652-6945.