E-Sign consent & disclosure

By clicking “I accept”, you agree to the following:

  1. Consent to Electronic Signature
    You agree that your electronic signature has the same legal effect as a handwritten signature for all purposes related to this invoice, including acknowledgment of receipt, authorization of payment, and acceptance of the terms stated herein.

  2. Electronic Delivery of Documents
    You consent to receive billing invoices, statements, and related communications electronically. You may request a paper copy at any time by contacting our office. No fees will be charged for paper copies.

  3. Right to Withdraw Consent
    You may withdraw your consent to use electronic records and signatures at any time by providing written notice to our office. Withdrawal will not affect prior transactions already signed and processed electronically.

  4. HIPAA Compliance
    All information transmitted or stored electronically is protected under the Health Insurance Portability and Accountability Act (HIPAA). We use secure systems to safeguard your Protected Health Information (PHI). By signing, you acknowledge that you have been informed of your rights under HIPAA.

  5. Accuracy of Information
    You affirm that the information you provide is true, accurate, and complete to the best of your knowledge.

Last updated at: Nov 7th 2025

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29457 Network Place Chicago, Illinois 60673 USA