1. Contact Information

2. SMS Communication Consent

✅ I consent to receive SMS messages from Soma Healthcare Solutions for the following purposes (check all that apply):

📩 Sample Message Examples:

• “Hello, this is Soma Healthcare. Reply STOP to opt out at any time.”
• “This is a billing reminder from Soma Healthcare. Reply STOP to unsubscribe.”
• “Soma Healthcare: New offers available! Reply STOP to opt out of marketing messages.”

3. Consent Details

• Message frequency may vary (e.g., up to 2–5 messages/week depending on services).
• Standard message and data rates may apply.
• Your phone number and information will not be shared with third parties for marketing purposes.
• You may opt out at any time by replying "STOP" to any message.

4. Opt-In Acknowledgment

Please confirm your consent by checking the box and signing below:

Signature

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Date:Printed Name:

5. Opt-Out and Help Information

• To opt out: Text STOP to any SMS message.
• To get help: Text HELP, call us at 917-339-3828, or visit www.somarcm.com/contact
• “Soma Healthcare: New offers available! Reply STOP to opt out of marketing messages.”

🔐 Privacy Policy & Terms

By Signing this form, you acknowledge our Privacy Policy and Terms of Use.

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