By submitting this form I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form

By choosing to use the convenience of e-mail to communicate, you express your understanding that the use of e-mail may pose risks to the confidentiality of information. The Internet is an open network and provides no inherent protection for confidential information. You accept these risks. You must contact me by telephone or in person about critical or time-sensitive issues, as there will be times when access to e-mail may be limited.

CONFIDENTIALITY NOTICE: This electronic message is intended to be viewed only by the individual or entity to whom it is addressed. It may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or copying of this communication is strictly prohibited without prior permission. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, or if you have received this communication in error, please notify us immediately by return e-mail and delete the original message and any copies of it from your computer system.