Avid Health At Home – SMS Consent Form

I ____ AGREE ___ DISAGREE to give my permission for Avid Health at Home to send me SMS messages related to my employment to my personal mobile phone.

 I understand that I can opt out at any time by Replying “STOP” to any message I received, or by notifying my branch office.

First Name ___________________

Last Name ___________________

Cell Phone ___________________

Email _______________________

Address ______________________

City, State, Zip ______________________________

________________________________     _______________________

Signature                                                                     Date