Communications over the Internet and/or using the email system are not encrypted and may not be secure. There is no assurance of confidentiality when communicated via email. To request that this provider communicate with you via email you must complete this form.
Please be advised that:
This request applies only to the healthcare provider that you indicate below. If you would like to request to communicate via email with another health care provider or program, you must complete a separate request for that office.
DR. MITCHELL A. KLINE will not communicate health information that is specially protected under state and federal law (e.g., HIV/Aids, substance abuse, mental health information) via email.
Your request will not be effective until you receive and respond appropriately to a test email message.