Prescription Message Service Authorisation Consent Form I give permission for Davidsons Chemists to contact me via SMS, voicemail regarding the status of my prescriptions. I confirm that I will advise the pharmacy if I change my contact details or wish to withdraw from the service. Text messages are generated using a secure facility and I understand that they are transmitted over a public network onto a personal telephone which may not be secure. However, the pharmacy will not transmit any information which would enable me to be identified. Name* Prefix MrMrsMissMsDrProf.Rev. First Last Date of Birth* DD MM YYYY Address* Street Address City ZIP / Postal Code Preferred method of contact*Mobile PhoneHome PhoneMobile Phone NumberName of account holder for mobile phoneI confirm this is my own personal mobile phone and understand that I cannot receive messages regarding prescriptions for a family member.Landline NumberIf you want text messages sent to a landline that can accept voice text messages, please note that some anti-cold calling blocks prevent this service.CAPTCHACommentsThis field is for validation purposes and should be left unchanged. 83047