Patient Information Opt-out

Select the communication channels you wish to stop receiving.

Marketing Communications

Stop receiving practice updates, newsletters, and special offers.

By opting out, you will no longer receive promotional materials, newsletters, updates about new services, or special offers. You may miss out on important non-medical updates from our practice.

PHI Data Usage

Revoke usage of Protected Health Information for personalized outreach.

By revoking this consent, we will limit the usage of your health records for personalized, non-essential communications. Note: This does not affect essential communications regarding your direct treatment or standard healthcare operations.

SMS/Texting Updates

Stop receiving appointment reminders and quick updates via text.

By opting out of SMS, you will stop receiving automated text message reminders for appointments. You will need to rely entirely on email or phone calls for scheduling updates.

All three options must be selected to proceed with an opt-out.

Verify Opt-Out Request

Please provide your contact information to locate your profile and apply these changes.

Verification Code *

Enter the 6-digit code we just sent you to verify your identity.

By confirming, you will be removed from the selected communication channels. Please note that it may take up to 48 hours for your request to be fully processed across all systems.

We Need Your Help

If the information entered does not match our records, please fill out this form and we will help you.

First Name *

Last Name *

Email Address *

Mobile Number *

Preferences Updated

Your communication preferences have been successfully updated. You have been opted out of the selected channels.