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By checking this box, I hereby authorize Dendro Technologies, Inc.(“Dendro") to release and disclose any information that I provide through this website or in response to any future surveys or requests from Dendro, and any information that Dendro collects from me through the CalmiGo device or the CalmiGo mobile application, to UnitedHealth Group (“UHG"), which I understand is the healthcare insurer that initially referred me to Dendro. I understand that UHG may use this information for any legal purposes, including but not limited to arranging my continued care, treatment, payment, and health care operations. I understand that once disclosed, this information may no longer be protected by state or federal privacy regulations. I may revoke this authorization at any time by notifying Dendro in writing at support@calmigo.com. However, if I revoke this authorization, I understand that it will not have any effect on any disclosures to UHG, which Dendro made before it received the revocation. I acknowledge that Dendro will not receive payment from UHG in exchange for any such information.