PATIENT ACKNOWLEDGMENT AND AGREEMENT
I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication Services more fully described above. I understand and accept the risks outlined above, associated with the use of the Services in communications with the Dr. Stark and Dr. Stark's staff. I consent to the conditions and will follow the instructions above, as well as any other conditions that Dr. Stark may impose on communications with patients using the Services.
Every good faith effort will be made by Dr. Stark and Dr. Stark's staff to protect sensitive information sent via the Services. I acknowledge and understand that despite this, it is possible that communications with Dr. Stark or Dr. Stark's staff using the Services may not be encrypted. Despite this, I agree to communicate with Dr. Stark or Dr. Stark's staff using these Services with a full understanding of the risk.
I acknowledge that either I or Dr. Stark may, at any time, withdraw the option of communicating electronically through the Services upon providing written notice.