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CONSENT FOR ELECTRONIC COMMUNICATION Name: Birthdate: / / Email address: (Please print clearly) Home Phone: Cell Phone: Check this box if you would like to receive appointment reminders via text message:
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How to fill out name birthdate email address

How to fill out name birthdate email address:
01
Begin by entering your full legal name in the designated name field. Make sure to include your first name, middle name (if applicable), and last name. Avoid using nicknames or abbreviations unless specifically requested.
02
Enter your birthdate accurately. Provide the day, month, and year of your birth in the appropriate fields. Double-check your entry to ensure accuracy, as it may be used for verification or age-related purposes.
03
Input your email address in the designated field. Provide a valid and active email address that you have access to. This is important as it will be used for communication purposes, such as receiving confirmation emails, updates, or important notifications.
Who needs name birthdate email address:
01
Job applicants: When applying for a job, potential employers often require your name, birthdate, and email address for identification purposes, age verification, and contacting you regarding the application process.
02
Online shoppers: E-commerce platforms and online stores require your name, birthdate, and email address to process your order, confirm your identity, and send you order updates, tracking information, and receipts.
03
Social media users: Almost all social media platforms ask for your name, birthdate, and email address when creating an account to ensure you are of age, personalize your experience, and allow for account recovery or communication with the platform.
04
Subscription services: Signing up for newsletters, online courses, magazines, or other subscription-based services usually entails providing your name, birthdate, and email address. This allows the service provider to deliver content, updates, and offers tailored to your preferences.
05
Event registrations: When registering for events, workshops, conferences, or seminars, organizers typically ask for your name, birthdate, and email address to verify your identity, communicate event details, and send any necessary reminders or confirmations.
Remember, it is crucial to provide accurate and up-to-date information when filling out name, birthdate, and email address fields to avoid any issues or complications in the future.
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