SMS Consent Form

Please complete this form to provide consent to receive SMS communications through VitalCX and the Grace platform.

First name

Last name

Phone number

Date of Birth

Clinic / Organization Name

By submitting this form, I agree to receive SMS messages from VitalCX through the Grace platform. These messages may include appointment-related notifications, callback updates, account access codes, operational alerts, and other service-related communications. Message frequency may vary depending on my interaction with the clinic and the services enabled. Message and data rates may apply. I understand that I can reply STOP at any time to unsubscribe from SMS messages, and HELP for assistance. I confirm that I am the owner or authorized user of the mobile phone number provided and consent to receive SMS communications at this number. I understand that SMS consent is not a condition of receiving care or services.

I have reviewed and agree to the SMS Consent Terms, Privacy Policy, and Terms & Conditions. By checking this box, I consent to receive SMS messages from VitalCX through Grace at the phone number provided.