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Compliance Documentation

SMS Consent & Opt-In Evidence

This page documents how patients of practices using Clearly Claims actively opt in to receiving SMS text message appointment reminders. It is published publicly so that Twilio and The Campaign Registry (TCR) reviewers can verify the opt-in flow without patient-portal credentials. The consent language below is reproduced verbatim from the live pre-visit intake form.

Last updated: September 16, 2026•Program: A2P 10DLC•Use case: Healthcare Appointment Reminders

Opt-In Methods at a Glance

Digital Intake Form

Patient checks the SMS consent box in the pre-visit intake form (patient portal). Unchecked by default — active consent required.

Verbal Consent

Front-desk staff read a standard script and record the patient's verbal consent, mobile number, and date/time in the patient record.

Paper Form

Patient signs a printed consent section on the intake paperwork authorizing SMS reminders at the provided mobile number.

Method 1

Digital Intake Form Opt-In (Patient Portal)

When a patient books an appointment, they are invited to complete a pre-visit intake form in the secure patient portal. On the final Consent step, the patient is presented with the SMS opt-in checkbox below. The checkbox is unchecked by default — the patient must actively check it to opt in. Consent is not required to submit the form or to receive care.

Pre-Visit Intake FormStep 5 of 5: Consent

We'll use this number to send your appointment reminder text messages.

SMS / Text Message Opt-In

Optional
I agree to receive SMS text messages from [Practice Name] via Clearly Claims for appointment reminders and related notifications. Message frequency varies. Message and data rates may apply. Reply STOP to opt out, HELP for help. Carriers are not liable for delayed or undelivered messages. Mobile information will not be shared with third parties or affiliates for marketing or promotional purposes. Terms: clearlyclaims.com/terms-of-service. Privacy Policy: clearlyclaims.com/privacy-policy.

You are not required to check this box to receive care. Checking it is voluntary and authorizes appointment reminder text messages only.

What is recorded on submission

  • sms_consent_given — boolean (true only if the patient checked the box)
  • sms_consent_timestamp — ISO timestamp of the opt-in
  • sms_consent_language — the exact consent text accepted by the patient
Method 2

Verbal Consent (Phone or In-Person)

Front-desk staff may obtain SMS consent verbally when scheduling an appointment by phone or at the front desk. Staff read the following script and, upon the patient's affirmative response, record the patient's name, mobile number, date/time, and a "verbal SMS consent given" note in the patient record.

“May we send you text message reminders about your appointments? You will receive a reminder before each scheduled visit. Message frequency varies, and message and data rates may apply. You can reply STOP to any message to opt out, or HELP for help. We will not share your mobile number with third parties for marketing purposes. May I have your mobile number and your verbal consent to receive these messages?”

Verbal consent is logged with the same elements required for written consent: the patient's identity, the mobile number authorized, the date and time of consent, and the disclosure that the patient was informed of STOP/HELP and that mobile information is not shared for marketing.

Method 3

Paper Form Consent

Patients who check in on paper complete a printed intake packet that includes the SMS consent section below. The patient (or authorized guardian) signs and dates the section and provides the mobile number to be used. The signed form is scanned and retained in the patient record.

SMS / Text Message Consent

I, _______________________________ (patient or authorized guardian), consent to receive SMS text messages from [Practice Name] via Clearly Claims at the mobile number provided below. I understand these messages are limited to appointment reminders and related notifications, that message frequency varies, that message and data rates may apply, and that I may reply STOP to any message to opt out or HELP for assistance. I understand my mobile information will not be shared with third parties for marketing purposes.

Mobile number: _______________________________

Signature: _______________________________   Date: ___________
Required Disclosures

Standard SMS Disclosures

The following disclosures are presented to every patient at the point of opt-in and are repeated in our Privacy Policy:

Message frequency varies (typically 1–3 reminders per scheduled appointment).
Message and data rates may apply, as determined by the patient's mobile carrier and service plan.
Reply STOP to any message to opt out. Upon opting out, no further SMS messages will be sent (except a single confirmation).
Reply HELP to any message for assistance and support contact information.
Mobile information and SMS data are not sold and are not shared with third parties for marketing purposes.
Patients may opt out at any time; opting out does not affect their right to receive care.

Note for Twilio / TCR reviewers: This page is intentionally public and requires no login. It reproduces the exact opt-in language, disclosures, and recording behavior used in the live patient intake form. The opt-in is active (unchecked by default), message content is limited to healthcare appointment reminders and related notifications, and no marketing or promotional messages are sent.