Text Message Read Receipt Confirmation
Please complete this form to confirm that you have read and received the specified text message. Your confirmation will be recorded for documentation purposes.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Sender's Name
*
Sender's Phone Number
*
Date and Time Message Was Sent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date and Time Message Was Read
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Message Content (copy/paste the text message that was sent)
*
How did you receive/read the message?
*
SMS/Text Message App
Messaging Platform (e.g., WhatsApp, iMessage)
Other
Please upload a screenshot or proof of the read receipt (if available)
Upload a File
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Submit Confirmation
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