* Required
** I wish to communicate with my care provider via email. I acknowledge and understand that these email messages are not encrypted and that the Centre for MindBody Health cannot guarantee the security of messages that I send or receive from my care provider.
I agree not to use email to communicate emergency or urgent health matters.
I acknowledge that at any time, I or my care provider can decide that we no longer wish to communicate through email. If I decide to stop communication through email, I agree to inform my care provider in writing or at my next appointment.