HIPAA Notice:
Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email / online form can be intercepted and read by other parties besides the person to whom it is addressed. Please do not include personal identifying information such as your birth date, or personal medical information on this form. No one can diagnose your condition from email or other written communications, and communication via our website cannot replace the relationship you have with a healthcare practitioner.