Legal

SMS communications consent.

This is the standard text-message consent form Cuepri, Inc. provides to the behavioral health treatment facilities that use its platform to run alumni and aftercare programs. Facilities collect this consent from each participant before any alumni program text messages are sent, retain the signed form, and provide Cuepri only the mobile numbers of individuals who have consented. Cuepri sends alumni program messages solely on the facility's behalf and only to consented recipients.

Alumni & Aftercare Program: Text Message (SMS) Consent

Collected by the facility. Retain the signed original.

[Facility Name] (the “Facility”) offers alumni and aftercare programming supported by Cuepri, Inc. (“Cuepri”), the software company that operates the Facility’s alumni support app and sends text messages on the Facility’s behalf.

I would like to receive text messages (SMS) from the Facility, and from Cuepri on the Facility’s behalf, at the mobile number I provide. Each option below is separate and optional. I may check either, both, or neither.

Optional — Marketing / promotional I agree to receive promotional text messages inviting me to join the Facility’s alumni support app and announcing alumni events and activities.
Optional — Non-marketing / operational I agree to receive non-promotional text messages such as reminders, follow-ups, and updates related to the alumni program.

Checking these boxes is optional. My consent to either or both is voluntary and is not a condition of receiving treatment, admission, or any other service from the Facility. If I check neither, I will still receive my care and services exactly the same.

I also understand that:

  • Message frequency varies and is low volume. Message and data rates may apply.
  • Messages may be sent using automated technology.
  • I may opt out at any time by replying STOP to any message. I may reply HELP, or email admin@cuepri.com, for assistance.
  • Messages will not reference my diagnosis or the details of my treatment.
  • My mobile number and consent information will not be sold, rented, or shared with third parties or affiliates for their marketing purposes. Cuepri’s handling of my information is described in its Privacy Policy and Terms of Use.
Participant full name
Mobile phone number
Participant signature
Date

Facility use only. Staff name and title: ________________    Facility: ________________    Date collected: ____________
Retain this signed form in the participant’s record. Proof of consent (including date, method, and the disclosures made) must be available to Cuepri or its messaging providers on request.

Facilities may reproduce this form on their own letterhead or incorporate it into intake or discharge paperwork, provided the disclosures above are presented clearly and conspicuously and the signed record is retained. Questions: admin@cuepri.com.