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E²AP Intake Form

Welcome to HIPAAtizer!

To complete setup, click 'Settings' on this widget to connect your HIPAAtizer form builder and start embedding secure, HIPAA-compliant forms on your site.

By submitting this form, you accept the risks of sharing health information via unencrypted email and messaging. By clicking "Send," you release Path Forward Counseling from liability for unauthorized use, disclosure, or access to your information.

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