By clicking “Ship” beneath, you might be indicating that you simply perceive and agree to those phrases concerning the usage of your data:
The data you submit on this manner can be used internally for the needs of processing and responding to your request. It might be routed internally so as to discover essentially the most applicable member of employees to deal with your request and your contact data will solely be used to reply to your inquiry in the event you point out permission to take action.
As well as, the knowledge submitted might turn into part of the affected person’s everlasting chart or remedy report at The Emily Program upon their utilization of The Emily Program companies, and this data could also be used within the planning of remedy and care offered to the affected person. On the time the affected person makes use of The Emily Program companies, The Emily Program’s Discover of Privateness Practices and different HIPAA and knowledge privateness and safety insurance policies will apply to the knowledge submitted on this manner and to another data that The Emily Program maintains concerning the affected person and the care offered to the affected person.