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This form is not for health information, and I consent to my contact information being used to respond to my inquiry. My message will be sent to this clinic via unencrypted email. Do not include symptoms, diagnoses, medications, or other sensitive details.

Messaging Terms and Conditions You agree to receive informational messages (appointment reminders, account notifications, etc.) from Balance BHRT. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at hello@balancebhrt.com. You can opt out at any time by replying STOP. See Privacy Policy & Terms and Conditions below. Mobile SMS Messaging Privacy Policy: Information collected: We may collect information, such as name, phone number, and email address. Use of information collected: We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests. Sharing of information collected: We may share information we collect with payment processors, legal authorities, partners so that these service providers can perform their normal duties. We do not share, sell, rent, or trade any information provided with third parties for promotional purposes. As a current or prospective patient, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help. You understand that the messaging frequency may vary. Messaging & data rates may apply. Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail