In order to facilitate the billing and payment of services provided at Networks, Inc., email communication between the client and Networks, Inc. may be available. However, we do not have secure email capabilities. This means that any information sent via email cannot be guaranteed to be private.
If you would like to be able to communicate through email regarding billing and payments, please sign below to acknowledge that you understand that those communications cannot be guaranteed as secure, private or confidential.
This authorization covers limited Protected Health Information (PHI) disclosed by Networks, Inc. clinicians to a client or client’s legal representative. PHI may include name, email address, phone number, insurance, billing and payment information. This authorization will expire upon 1) end of treatment, 2) completion of billing & payments, and/or 3) when revoked by the client.