I acknowledge that I am not including any protected health information (PHI) in my inquiry. I understand that any such information should be presented in person or securely over the phone with my health care provider. PHI, as defined by HIPAA includes, but is not limited to, any information that relates to 1) the past, present, or future physical or mental health or condition of an individual, 2) the provision of health care to an individual or 3) the past, present, or future payment for the provision of health care to an individual that identifies the individual.
I consent to allow electronic communications with Clearwater Therapeutics regarding this inquiry. These communications include this web form, emails, and website comments. I understand that electronic communication is not secure and that any information that I provide here may be visible to third parties. I waive my rights under HIPAA to the extent that they can be waived and do not hold the recipient liable to any breaches or disclosures of the information provided in this message.
