CACC CONTAC eatin | understand that as a service to its patients, NYU Langone (Faculty Group Practice) provides bill pay reminders to patients that may be placed using a prerecorded message or text message. By providing my cell phone number to NYU Langone and signing below, | am giving consent to receive these calls or text messages at the number maintained in my NYU Langone medical record. | understand that if my cell phone number is updated at NYU Langone, | will receive the calls or text messages to the new number, unless | have opted out as described below. | also understand that this consent will apply to any NYU Langone Faculty Group Practice office that may use this service. C11 Give CONSENT for NYU Langone to contact me regarding bill pay reminders on my cel phone. Oo | DENY CONSENT for NYU Langone to contact me regarding bill pay reminders on my cell phone. | understand that | can opt-out at any time by emailing my name and date of birth (for verification) to NYUPhysicianServices@nyulmc.org, submitting a message via MyChart, or by providing written notice to: NYU Langone Physician Services, PO Box 415662, Boston, MA 02241 -|\- a Patient (Parent/Guardian) Signature Date EFTA00313915