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Informed Consent to Web Based Communication

This email form may be used to request general information and ask non-urgent questions only. Do not use it to send or request sensitive information or personal information you do not want other people to know about. I will not share your information with anyone unless required to do so by the law, and I will use the minimum necessary amount of personal information, including personal health information, to respond to your query. However, as with regular email, this form will not be encrypted, so there is some risk that the information contained in it may be disclosed to, or intercepted by, unauthorized third parties.

By submitting this form you acknowledge and accept the possible risks associated with such communication and provide your consent to communicate via email. Additionally, you agree not to hold me responsible or liable in the event that such information is inadvertently released or accessed by third parties without my consent. Please consider communicating any sensitive information in person or by telephone.

If you know or suspect you have a medical condition consult your physician.. In cases of medical emergency call 911.

Thank you.

Miyuki Seko, L.Ac.
Peaceful Waves Healing Center
5812 East Naples Plaza
Long Beach, CA 90803
562.289.0002