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Please be aware that communication sent via email or website form submissions may be intercepted during transit. By submitting this form, I hereby give consent to ProHealthDesk LLC to send electronic communication to me that may contain Protected Health Information (PHI) as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I understand that I can also call the Patient Support line at (980) 342-2090 or send this information via fax to (727) 800-2333.