Communication Preferences – Population Health 125

Communication Preference Form

Review and submit your choices

Complete the form below. Optional communication boxes are not required to submit your preferences.

Population Health 125 Communication Preferences Please review each section carefully before submitting.

PH125-CONSENT-FRM-001 · v1.0

PH125-CONSENT-FRM-001 • Version 1.0

Employee Communication Preferences

Separate, optional consent choices for Population Health 125 email and SMS communications.

Important Your communication choices are voluntary. The email and SMS boxes below are separate, optional, and not preselected. Declining electronic communications does not determine your employment or your eligibility to participate in an employer-sponsored Population Health 125 program.

Participant Information

Your Contact Information

Employee / Participant Name *

Employer *

Email Address *

Mobile Phone Number *

1. SMS Account Notifications

Optional SMS Consent

The checkbox below is optional and must remain unchecked unless you choose SMS notifications.

SMS ACCOUNT NOTIFICATIONS (OPTIONAL)I consent to receive recurring automated SMS/text messages from Population Health 125 at the mobile number I provide concerning my employer-sponsored Population Health 125 program. Messages may include account and program notifications, enrollment and eligibility information, benefit access instructions, activation and onboarding information, reminders, wellness activity notices, support messages, and important program updates. Message frequency varies, generally 1-8 messages per month. Message and data rates may apply. Reply STOP to opt out at any time and HELP for help. Consent is not a condition of purchasing goods or services or participating in the program. I confirm that I am the subscriber or authorized user of the number provided. Privacy Policy: https://populationhealth125.org/privacy-policy/ | Terms and Conditions: https://populationhealth125.org/terms-and-conditions/

Required live links: Privacy Policy | Terms and Conditions

After this form is submitted, Population Health 125 will send a verification text requiring a YES response before recurring SMS begins. If you do not reply YES, recurring SMS will not be activated. Reply STOP at any time to opt out. Reply HELP for assistance or contact Population Health 125 using the information below.

2. Email Account and Program Notifications

Optional Email Consent

EMAIL ACCOUNT AND PROGRAM NOTIFICATIONS (OPTIONAL)I consent to receive email from Population Health 125 concerning my employer-sponsored Population Health 125 program, including enrollment, eligibility, account, benefit-access, onboarding, reminder, support, and administrative notices. Email frequency varies, generally 1-8 emails per month. I may withdraw this consent or update my preferences at any time. Certain messages specifically requested by me or necessary to complete a transaction I initiate may still be sent as permitted by law.

After you submit this form, Population Health 125 may send a verification email. Optional recurring email is not activated until you complete the verification step. You may update preferences through the link in applicable emails or by contacting PH125.

3. Optional Educational and Engagement Emails

Separate Optional Email Consent

OPTIONAL EDUCATIONAL AND ENGAGEMENT EMAILSI separately consent to receive educational, wellness-engagement, survey, incentive, and program-awareness emails from Population Health 125. This box is optional, is not preselected, and is not required to receive or participate in employer-sponsored benefits. Each applicable email will provide a clear unsubscribe method.

4. Separate Policy Acknowledgment

Acknowledgment — Not Bundled With Channel Consent

Policy Acknowledgment *I acknowledge that I have been provided access to the Population Health 125 Privacy Policy and Terms and Conditions. This acknowledgment is separate from, and does not replace, my optional email or SMS choices above.

5. Certification and Signature

Certification

By signing below, I certify that the contact information I provided is accurate, that I am the owner or authorized user of the email address and mobile number, and that the selections above reflect my choices. I understand that I may withdraw consent through the methods described above. Electronic records, including timestamps and verification events, may serve as evidence of my selections.

Signature (type full legal name) *

Date *

Printed Name *

Employee ID (optional)

Population Health 125, LLC
14 Wall Street, New York, NY 10005 | 800-983-2611 | support@populationhealth125.org
Controlled Form: PH125-CONSENT-FRM-001 / Version 1.0 / Effective August 28, 2026

Privacy & Terms

Review how Population Health 125 handles personal information and the terms that apply to electronic communications.

Need Help?

Population Health 125 support is available for questions about communication preferences or your employer-sponsored PH125 program.

800-983-2611 support@populationhealth125.org

For SMS communications, message frequency varies and may generally be 1–8 messages per month. Message and data rates may apply. Reply STOP to opt out and HELP for assistance. The detailed consent disclosure and current communication choices are presented inside the form above.