COMMUNICATION CONSENT FORM

Benefit Planning Solutions Inc.
Communication Consent Form

Benefit Planning Solutions Inc. offers optional appointment reminders and confirmations by text message and email. Completing this form is entirely voluntary.

These options are optional. Consenting to receive text messages or emails is not required to become a client or to receive any of our services. You will receive full service whether or not you choose to opt in to either.

What you'll receive: If you opt in, we will send appointment reminders and confirmation requests related to your own scheduled appointments. We do not send marketing or promotional messages. Message frequency varies based on your appointments.

Cost: For text messages, message and data rates may apply, depending on your mobile carrier and plan. We do not charge for these messages.

Opting out: You can opt out of text messages at any time by replying STOP to any message. You can opt out of emails at any time using the unsubscribe link in any email or by contacting our office. For help, reply HELP to any text, or call us at 215-760-6171.

Your information: We do not share, sell, or provide your mobile phone number, email address, or messaging consent to third parties or affiliates for marketing or promotional purposes. Your information is handled according to our Privacy Policy at bpsgroup.org/privacy-policy.

Please check the options you would like (both optional):

☐ TEXT MESSAGES — I agree to receive appointment reminder and confirmation text messages from Benefit Planning Solutions Inc. at the mobile number I provide below. I understand this is optional and not required to receive services, and that I can opt out anytime by replying STOP.

Mobile phone number: _______________________________

☐ EMAIL — I agree to receive appointment reminder and confirmation emails from Benefit Planning Solutions Inc. at the email address I provide below. I understand this is optional and not required to receive services, and that I can unsubscribe at any time.

Email address: _______________________________

Client name (print): _______________________________

Signature: _______________________________ Date: ____________