Healthcare Services in New York | Multi-Specialty Practices

Portal Support – Please Complete

This form is NOT for: billing, online scheduling, prescription requests, updating contact information, canceling/rescheduling appointments, etc.
Please refer back to the main Contact Us page here.
ONLY use this form for Patient Portal enrollment and/or questions regarding using it.
This form is monitored by Portal Support Representatives, NOT clinicians.

BY SENDING MESSAGE, I CONSENT TO USE OF UNENCRYPTED EMAIL

I understand that I am sending an unencrypted email message to CareMount Medical, P.C. I acknowledge and understand that unencrypted email messages are not protected, and that there is a risk of a violation of my privacy, which may include my personally identifiable health information being accessed or viewed by an unintended third party while in transit or when stored on an electronic device, or by hacking or some other means.

I acknowledge that email messages may be inadvertently sent to the wrong email address and may be subject to technical malfunctions. Therefore, I understand that email message delivery is not guaranteed. I understand and acknowledge that CareMount Medical, P.C. has no responsibility for the content of my email if I happen to misplace my device, if someone views my email messages, or if my device is stolen. I understand that the email messages will be delivered across the networks of various third parties (such as Apple, Verizon, Sprint, etc.), and CareMount Medical, P.C. makes no representations or warranties regarding the quality, reliability, timeliness or security of such third party networks, or their services or equipment.

Despite the risks, I am authorizing CareMount Medical, P.C. to communicate with me via email, including by exchanging personally identifiable health information.

I understand that I am responsible for notifying CareMount Medical, P.C. in writing if I choose to discontinue email communications or if my email address changes.

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