Obtaining Opt-In With a Paper Form

Following this basic format with your opt-in form will help ensure your registration is approved.

Example Documents

Sample Opt-In Form

Required Information

Required Information Description Example
Description of your opt-in workflow.  A brief summary of the process that you go through when getting communication opt-in from your customers.  "When enrolling new customers, we give them a paper form where we gather important information. As part of that form, we give them the opportunity to opt in to text communications."
An image of or copy of your form. You will need to upload an image or PDF of your paper form that includes the area where you give the customer the option to opt-in.  Sample Opt-In Form PDF

Best Practices

Ensure that your paper form contains the following information:

  • A statement of non-sharing of mobile numbers
  • A statement on how often messages will be sent (if you’re unsure, you can say “Message frequency may vary.”
  • A disclosure that message and data rates may apply
  • A disclaimer that message and data fees may apply
    Informs customer of how to opt out (Reply STOP to unsubscribe)

We also recommend that you upload two files for your registration submission:

  • An image or PDF of your entire form
  • A close-up image of the area on your form where customers can opt in

Sample Opt-In Language

Text-Messaging Opt-In

Please check the box below to give your consent and opt in to receive text messages from our dental office. By opting in, you agree to receive appointment reminders, important updates, and exclusive offers via text message. Standard messaging rates may apply. 

[ ] I consent and opt in to receive text messages from [business name].

You can opt out at any time by replying STOP to any message.