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ive the calls or text messages to the new number, unless I have opted out as described below. I also understand that this consent will apply to any NYU Langone Faculty Group Practice office that may use this service. El I GIVE CONSENT for NYU Langone to contact me regarding bill pay reminders on my cell phone. K I DENY CONSENT

y name and date of birth (for verification) to [email protected] submitting a message via MyChart, or by providing written notice to: NYU Langone Physician Services, PO Box 415662, Boston, MA 02241 Patient (Parent/Guardian) Signature Date EFTA00313915

eive the calls or text messages to the new number, unless I have opted out as described below I also understand that this consent will apply to any NYU Langone Faculty Group Practice office that may use this service. 0 t GIVE CONSENT for NYU Langone to contact me regarding bill pay reminders on my cell phone. CI I DENY CONSENT

ame and date of birth (for verification) to NYUPthiniirenServicestpnyulnic ort submitting a message via MyChart. or by providing written notice to: NYU Langone Physician Services, PO Box 415662, Boston, MA 02241 EFTA00304450 IIBUr HEALTH INFORMATION EXCHANGE. CARE EVERYWHERE AND HEALTHIX CONSENT FORM In this Consent EO

ive the calls or text messages to the new number, unless I have opted out as described below. I also understand that this consent will apply to any NYU Langone Faculty Group Practice office that may use this service. K I GIVE CONSENT for NYU Langone to contact me regarding bill pay reminders on my cell phone. K I DENY CONSENT

name and date of birth (for verification) to [email protected], submitting a message via MyChart, or by providing written notice to: NYU Langone Physician Services, PO Box 415662, Boston, MA 02241 Patient (Parent/Guardian) Signature Date EFTA00308059 , NYU Langone Health HEALTH INFORMATION EXCHANGE, CAR