I authenticate all communications between BULGER SWPain and the e-Mail address are from me. I approve all e-Mail responses from BULGER SWPain and grant full disclosure of information to the withheld e-mail address.

I understand and acknowledge that communications over the internet are not secure, and that there is potential risk for compromise of personal and medical information during internet exchanges.

I hereby release BULGER SWPain from all responsibility related to exchange of personal and medical information via unsecured internet pathways.