As of Mar. 9, 2014 - 12:43 PM | What does this mean?
General Internet communication is inherently not secure. For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form (e.g., Social Security Numbers, Diagnosis Information, Credit Cards Numbers, etc.).
Click on the checkbox below to affirm that you understood this statement.
Yes, I understand the above statement.*