It may occasionally be useful or necessary to send you information by email. It is your right to be informed about the risks of communicating by email that will be used to disclose provider/client information.
 
Email messages sent to you are not guaranteed to be secure, HIPAA compliant, encrypted, private, or confidential.
 
If there is an emergency or urgent situation, call 911 or go to the nearest emergency room for treatment.
 
If you believe that this would compromise your privacy or safety, you have the right to deny permission and request an alternate form of communication, such as phone contact. If your circumstances change, you can revoke permission to receive email at any time.
 
You acknowledge and understand the importance of this permission form and accept full responsibility for information communicated through email.
 
You agree that Integrative Counseling Solutions LLC and individuals associated with the office not responsible from any, and all claims and liabilities arising from the information through email.
 
 
 Permission for the staff of Integrative Counseling Solutions, LLC to send written communication to my Email.  I understand that I may withdraw this permission at any time and will need to sign a new permission form at that time to update file.