We do not
sell or distribute your personal information to anyone other than the
doctor on this website. By checking the box you agree to have your
information e-mailed to the doctor so that he can evaluate the survey/test
you filled out. By checking the box you also agree that you would like to
have the doctor provide you with feedback as it relates to your completed
like to hear the results of your assessment and the recommendations of care via the telephone or email?