Consent to Receive Text Messages
Effective date: September 3, 2026
This page is a reference copy. There is nothing to fill in or sign here. Your care team gives you this form when you enroll in our chronic care management and remote patient monitoring programs, and you opt in by signing that copy, on paper or electronically. If you do not sign, we do not text you.
This is the opt-in form for the ClearView Patient Messaging program. Patients receive it when enrolling in our chronic care management and remote patient monitoring programs and opt in by signing it, on paper or electronically. We send text messages only to patients who have signed this form. The form patients sign reads as follows.
How this works
Signing this form is how you say yes to text messages. If you do not want text messages, do not sign it. There is no one you need to tell.
Not signing costs you nothing. Consent to text messages is not a condition of receiving care, of enrolling in any program, or of purchasing anything. If you do not sign, we will not text you and will reach you by phone, patient portal, mail, or email instead.
The program
Program name: ClearView Patient Messaging. ClearView Medical Associates-TX, P.C. (the "Practice") and those acting on its behalf may text the mobile number in your patient record, from any Practice number, including the practice line and your care team line. Messages cover appointments, care coordination and check-ins, remote monitoring reminders, prescription and result notices, and billing notices. No marketing texts, and we do not sell your information.
Frequency and cost
Message frequency varies, up to approximately 30 messages per month. Message and data rates may apply from your carrier. The Practice does not charge you for text messages.
How to stop
Reply STOP to any message. END, QUIT, CANCEL, UNSUBSCRIBE, and REVOKE also work. Reply START to begin again, or HELP for help. You may also stop by telling your care team, calling (325) 603-3617, updating the patient portal, or writing to privacy@clearviewmedicalassociates.com; we honor requests within 10 business days. Tell us if your mobile number changes, so messages are not sent to someone else.
Privacy and emergencies
Texts are not secure and may be read by anyone with access to your phone, so we limit what we put in them to the minimum necessary. Texts are not monitored around the clock. For a medical emergency, call 911.
Terms
https://clearviewmedicalassociates.com/sms-terms and https://clearviewmedicalassociates.com/privacy-policy
Mobile number to text (we save it to your patient record): ______________________
Your signature is your consent
Yes, I consent to receive text messages from ClearView Medical Associates-TX, P.C. at the mobile number above.
By signing this document, I give ClearView Medical Associates-TX, P.C. my express written consent to send me text (SMS) messages, including messages sent using automated technology, at the mobile number above, for the purposes described above. Reply STOP to opt out; reply HELP for support; message and data rates may apply; messaging frequency may vary. I understand that consent is not a condition of receiving care and that I may stop at any time by replying STOP or by any other reasonable method.
If I do not sign this form, I am not giving consent, the Practice will not send me text messages, and nothing about my care changes.
If I am signing for a patient as parent, guardian, or authorized representative, I certify that I have authority to do so and that the number in the record is one I control. My electronic signature has the same effect as a handwritten signature.
Questions
To ask about this form or the ClearView Patient Messaging program before deciding, call (325) 603-3617 or email care@clearviewmedicalassociates.com. The program's full terms are in our SMS Terms & Conditions, and our privacy practices are described in our Privacy Policy.