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IF THIS IS A MEDICAL EMERGENCY, PLEASE IMMEDIATELY CALL 911 FOR PROMPT MEDICAL ATTENTION. DO NOT RELY ON ELECTRONIC COMMUNICATIONS FOR ASSISTANCE IN REGARD TO YOUR IMMEDIATE, URGENT MEDICAL NEEDS. THE ONLINE APPOINTMENT REQUEST FORM IS NOT MONITORED FOR PURPOSES OF RESPONDING TO EMERGENCIES.Summit Healthcare Association takes your privacy very seriously. Please refer to our website Terms of Service and Terms of Use, as well as our Notice of Privacy Practices for more information. Our Notice of Privacy Practices describes our use and disclosure of protected health information, and the steps we take to safeguard your protected health information.The Summit Healthcare Association website is designed and created by Advice Media. The website maintains a current security certificate, which means information you send or receive through the website is private. Nevertheless, in rare instances, security protocols could fail, causing a breach of privacy and/or security of protected health information. IN NO EVENT WILL SUMMIT HEALTHCARE ASSOCIATION, ITS AFFILIATES, SERVICE PROVIDERS, EMPLOYEES, AGENTS, OFFICERS OR DIRECTORS BE LIABLE FOR DAMAGES OF ANY KIND, ARISING OUT OF OR IN CONNECTION WITH YOUR USE, OR INABILITY TO USE, THE ONLINE APPOINTMENT REQUEST FORM, INCLUDING ANY DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY, PAIN AND SUFFERING, EMOTIONAL DISTRESS, LOSS OF REVENUE, LOSS OF PROFITS, LOSS OF BUSINESS OR ANTICIPATED SAVINGS, LOSS OF USE, LOSS OF GOODWILL, LOSS OF DATA, AND WHETHER CAUSED BY TORT (INCLUDING NEGLIGENCE), BREACH OF CONTRACT OR OTHERWISE, EVEN IF FORESEEABLE.THE FOREGOING DOES NOT AFFECT ANY LIABILITY WHICH CANNOT BE EXCLUDED OR LIMITED UNDER APPLICABLE LAW.The personal information collected by using the online appointment request form consists of name, address, phone number, email address, and date of birth. By utilizing our online appointment request form, you specifically consent to the use of this information to facilitate an appointment with a Summit Healthcare Association provider. If you do not want us to use your information as stated in this disclaimer or our Privacy Practices, please do not use the online appointment request form.