SMS Consent
Optional Pharmacy 575 Text Messages
You can choose to receive Pharmacy 575 patient service texts. Signing or acknowledging our HIPAA privacy notice does not enroll you. You can receive pharmacy care whether or not you agree to texts.
What you may receive
Prescription status and pickup notices, refill reminders, preparation-preference requests, appointment reminders, and individualized care follow-ups. Messages may be sent using automated technology. This permission does not include advertising or promotional offers.
Message frequency varies. Message and data rates may apply. Reply STOP to stop messages or HELP for help. For assistance, call 575-263-2908 or email office@pharmacy575.com. Texts are not monitored continuously and must not be used for emergencies.
Read our Privacy Policy and SMS Terms before making your choice. Ask staff for paper copies if needed. Mobile information and SMS consent are not shared with third parties or affiliates for marketing or promotional purposes.
Your separate SMS choice
YES — I choose to receive Pharmacy 575 patient service text messages at the mobile number I provide below. I have had the opportunity to review the Privacy Policy and SMS Terms. I understand that consent is optional and is not a condition of purchasing products or receiving care. I am the subscriber or customary user of the number, or I am authorized to give this permission. SMS may be visible to others with access to my phone or mobile account.
NO — I do not want to enroll in pharmacy text messages.
Leaving this section blank does not enroll you. Please select only one choice.
Patient name:
Mobile number for texts:
Name of person giving permission:
Relationship to patient, if applicable:
Signature for SMS choice:
Date and time:
How to use this form
Complete it at Pharmacy 575 and give it to pharmacy staff. Do not send completed forms containing patient information to a public website or public document link. This web page explains the program and provides a printable form; it does not enroll you online.
Pharmacy 575 · 305 E Sanger St, Hobbs, NM 88240 · 575-263-2908