I expressly permit CARE2U, at its discretion, to communicate my PHI, via email at the e-mail address I indicated on this form.


At the discretion of CARE2U and upon your agreement to the terms outlined within this consent form, CARE2U may use e-mail to communicate with you. These e-mails may contain your personal health information. If you agree to permit CARE2U to use e-mail to communicate with you, you should be aware of the following risks and/or your responsibilities:

a) As the Internet is not secure or private, unauthorized people may be able to intercept, read and possibly modify email you send or are sent by CARE2U;

b) You must protect your e-mail account, password and computer against access by unauthorized people;

c) Since e-mail can be used to spread viruses, some which cause e-mail messages to be sent to people who you do not intend to send e-mail messages to, you should install and maintain virus protection software on your PC or other personal device;

d) Since e-mails can be copied, printed and forwarded by people to whom you send emails, you should be careful regarding whom you send e-mails;

e) You shall immediately inform those individuals with whom you communicate with at CARE2U of changes in your e-mail address; and

f) You shall send e-mails only to such CARE2U e-mail addresses as instructed.


CARE2U will use reasonable means to protect the privacy of the patient’s health information. However, because of the risks outlined above, CARE2U cannot guarantee that e-mail will be confidential. Additionally, CARE2U will not be liable in the event that you or anyone else inappropriately uses or accesses your e-mail. CARE2U will not be liable for improper disclosure of your health information that is not caused by CARE2U’s intentional misconduct.