1. Mobile Phone Communication. Please note that if we communicate via my mobile phone by voice or text, your phone number will be stored in the phone’s memory for a period of time and therefore if my mobile phone is lost or stolen, it is theoretically possible that your contact information might be accessed. Note that my mobile phone is itself password protected providing one line of defense against such a
breach.

2. Email Communication. If you elect to communicate with me by email, please be aware that email is not completely confidential. While I have a HIPAA compliant email account and layers of passcodes for security, all emails are retained in the logs of your, and/or my, internet service provider. Any email I receive from you, and any responses that I send to you, will be considered part of your treatment record.
2a. Please be aware that I regularly access email communications via my
password-protected mobile phone. It is theoretically possible that if my mobile phone is lost or stolen and the password is somehow circumvented our email communications could be accessed.

By signing below, I am giving consent for communications via EMAIL, PHONE
CALL, and TEXT MESSAGE.
Signature: ______________________________________ Date: ___________.