Patient Consent Form

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Patient Consent Form (with Text Opt-In)

Please fill out this form to provide your details.

Name(Required)

First Last

Email(Required)

Phone(Required)

Opt-in for Text Messages from SportsMed(Required)

Yes

* I consent to receive text messages from SportsMed Physical Therapy regarding my inquiry, and related services. Message and data rates may apply. I understand I can reply STOP to opt out at any time. View our [Privacy Policy]. Your consent to receive text messages is not required as a condition of receiving care at SportsMed Physical Therapy.

How do you prefer we contact you?

Phone

Are you a new or returning patient?

How did you hear about us?

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Patient Consent Form

Patient Consent Form (with Text Opt-In)