Text - B&B Care Services, Inc.

Participant Name:(Required)

Full Name

Date of Birth:(Required)

Phone Number for Text Messages:(Required)

Purpose of This Form
B&B Care Services, Inc. is committed to clear and timely communication. We offer text messaging as a convenient option for brief service-related updates.

What You Can Expect
If you agree, you may receive text messages related to:

Appointment reminders or changes
Brief, non-clinical check-ins from your Case Manager, Nurse, or other team member
Requests to return a call or follow-up on services
General program updates

Text Messaging Will Not Be Used:

To share detailed health or personal information
For emergencies or urgent messages
To replace required monthly contacts or in-person visits

Privacy Notice

Text messages are not encrypted and may be viewed by anyone with access to your phone.
B&B Care Services, Inc. cannot guarantee message security over wireless networks.
You are responsible for keeping your phone secure and notifying us if your number changes.

Your Rights

You are not required to agree to text messaging; we can continue to contact you by phone or mail.
You may opt out at any time by replying “STOP” or notifying your staff contact.
Opting out will not affect your eligibility for services.

Your Consent:(Required)

I give B&B Care Services, Inc. permission to send text messages to the phone number I provided for service-related communication.

I acknowledge that I understand the risks and limitations of text messaging, including potential privacy concerns.

I understand that text messaging does not replace required monthly contacts or in-person visits.

I understand that I may withdraw my consent to receive text messages at any time.

Participant Signature:

Date:

If Legal Guardian or Representative:

Legal Guardian/Representative Printed Name:

Full Name

Legal Guardian/Representative Signature:

Date:

Submission Reminder
If you don’t see a button to submit this form, you have not checked all four boxes to give your consent above. Thank you very much for your cooperation.