By clicking “I agree”, I am providing my authorization and hereby request 9amHealth Medical Group, P.C. and its other affiliated professional entities, to use and/or disclose the protected health information described below to 9amHealth Inc. and its affiliates (“9amHealth”). 

1. I understand that by checking the box associated with “I agree”, I hereby authorize the release of my entire health record held by each Covered Entity, which includes all protected health information submitted by me or about me in connection with the health care services provided to me by such Covered Entity (the “Health Information”).
    
2. The purpose of this authorization is to authorize 9amHealth to use the Health Information to provide me with services that are ancillary to the health care services I receive from each Covered Entity in addition to allowing 9amHealth to conduct additional research and development of its healthcare data and technology products.  
   
   
3. This authorization is in effect until the revocation of this authorization.
   
   
4. I understand that I have the right to revoke this authorization, in writing, at any time by sending notice to support@9am.health.  The revocation will be effective immediately upon 9amHealth receipt of my written notice, except that the revocation will not affect any uses or disclosures that were already made by a Covered Entity to 9amHealth prior to receipt of the written notice of revocation.
   
   
5. I further understand that if the person or entity that receives my Health Information is not required to comply with the applicable privacy regulations, then the Health Information described above may be re-disclosed by the recipient and is no longer protected by the HIPAA privacy rule.
   
   
6. I am accepting this authorization voluntarily and I understand that my treatment or eligibility by any party may not be conditioned upon my acceptance of this authorization, and that I may refuse to accept this authorization.
   
   
7. I can receive a copy of this authorization at https://join9am.com/health-information-release. We may, in our discretion, modify or update this Authorization from time to time, by posting such changes through the service or making the changes available through any other reasonable means. Please check back to determine if this Authorization has been changed—the date on which this Authorization was last updated is indicated above. Your continued access to or use of the service after any such change constitutes your acceptance of the change.