I , agree to regard all information relating to patient, clients, employees, and Unity in general, written or otherwise, as confidential.  I will not communicate information regarding a patient’s or client’s medical records, diseases or other conditions, or personal or family history to anyone other than the professional and paraprofessional personnel who require such information to treat Unity Health Care Inc.’s patients or clients.

This agreement is binding for the entire time I will be observing or shadowing at Unity Health Care Inc.  I understand that breaking this agreement may result in the termination of my learning experience at Unity Health Care Inc.

 Name:                           Date:

The electronic submission of this form  indicates that I agree to abide by the rules and restrictions stated above.