Our Chiropractic Care Frequently Asked Questions

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Email Communication Release Form

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I would like to communicate electronically with Ryan Slaughter Chiropractic Corp and their staff on matters related to my health and/or my medical treatment. Electronic communication includes email, text message, fax, or social media. I understand that any Confidential Health Information that I send to that practice is not secure and is sent at my own risk. I will not hold the practice, nor any of its workforce members, liable for loss of any confidentiality associated with information transmitted via email.

I also understand that it is not the policy of the practice to encrypt any Confidential Health Information I request to be sent to me via email. Because this information is not encrypted, I understand that it is not secure. I acknowledge this risk and will not hold the practice or any of its workforce members liable for any loss of confidentiality associated with such transmissions.

____________________________________ ________________________________(Signature) (Date)

 

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