“I understand and acknowledge that communications over the Internet and/or using the email system may not be encrypted and may not be secure; that there is no assurance of confidentiality of information when communicated this way.

I understand that all email communications in which I engage may be forwarded to other providers for purposes of providing treatment to me.

I agree to hold Columbia University Medical Center and individuals associated with it harmless from any and all claims and liabilities arising from or related to this request to communicate via email.”