Permission to Communicate by Text Message

Tzvi Wertheimer, LMHC · Brooklyn, NY

Last updated 10 September 2026


Clients of this practice give their mobile number to the practice themselves, at registration, and sign the form below before any text message is sent to them. No numbers are bought, rented, or obtained from anybody else, and the practice sends no marketing messages.

The form is reproduced here exactly as a client completes it. This page is a copy for reference — it collects nothing and sends nothing. The form is signed on paper at the office, or on the client's own secure page.

The form

Permission to Communicate by Text Message

Client name
Mobile phone number
Date

I agree to receive text messages from Tzvi Wertheimer, LMHC at the mobile number I have given above.

I do not want text messages. Please contact me by telephone instead.

The messages I will receive are appointment reminders, scheduling changes, and administrative correspondence about my care. Message frequency varies. Message and data rates may apply. I can reply STOP at any time to stop receiving messages, or HELP for help.

I understand that agreeing to text messages is not a condition of receiving services from this practice, and that I may change my mind at any time by telling the practice or by replying STOP.

I understand that a text message is not a secure or private way to send health information, and that it can be seen by anybody with access to my phone. I understand that I should not use text messages for anything urgent, and that in an emergency I should call 911 or go to the nearest emergency room.

Your mobile information will not be sold or shared with third parties for promotional or marketing purposes. See the practice's Privacy Policy.

Signature
Date signed

What the client receives first

Once the form is signed and the number is on the record, the practice sends a single confirmation message. It is the first message any client receives:

Tzvi Wertheimer LMHC: you are subscribed to appointment reminders and messages from the practice. Message frequency varies. Msg & data rates may apply. Reply HELP for help, STOP to opt out.

What the messages look like

Reminder: your appointment with Tzvi Wertheimer LMHC is tomorrow at 3:00 PM. Reply STOP to opt out.
Your appointment has been rescheduled to Thursday at 11:00 AM. Reply STOP to opt out.

Every message the practice sends ends with “Reply STOP to opt out.” — added by the practice's own system rather than typed, so it is on every message and not only the first.

Stopping, and getting help

Contact

Tzvi Wertheimer, LMHC
Brooklyn, New York
tzvi@twclmhc.com
(929) 542-3323