Use this form to inform our office of your preferred method of contact when reminding you of upcoming appointments and important information. Full Name* First Last Preferred Method*Phone CallText MessageEmailPhone Number*Cell Phone Number*Email Address* Terms & Conditions*- You will receive confirmation messages for upcoming appointments and available appointments that meet your needs - You will receive no more than 6 messages per month per person per contact number - Message and date rates may apply - You may opt out of the program at any time by replying STOP - Your contact information will not be sold, traded, or given to Any third party It is important to note that text communication is not always secure. Text messages can be intercepted and for this reason, we do not communicate personal health information through this method. I accept. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.