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I understand that when submitting personal information on-line, there is always a risk of a third party either intentionally or unintentionally accessing my information. Creekside Counseling ensures the security of your protected health information with HIPPA compliant data security upon receipt by the counselor, but during transmission from me to the counselor and/or if I choose for the counselor to respond to my request via text or email, I understand that my information could be intercepted by a third party. By checking this box, I am indicating that I choose to accept this risk for the purposes of transmitting this form.
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I understand that when submitting personal information on-line, there is always a risk of a third party either intentionally or unintentionally accessing my information. Creekside Counseling ensures the security of your protected health information with industry-standard HIPAA-Compliant data security upon receipt by the counselor, but during transmission from me to the counselor and/or if I indicate a preference for the counselor to respond to my request via text or email, I understand that my information could be intercepted by a third party. By checking this box, I am indicating that I choose to accept this risk for the purposes of transmitting this form.
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