Before taking this Health Assessment, please read the following information carefully:
The Health Assessment is a learning tool designed for adults 18 years and older living in Customer Potential Management service areas, and was developed using research from the U.S. Centers for Disease Control. The Health Assessment can help you to identify specific health risks and tell you how to make choices for a healthier life. After you complete this quiz, you'll receive your individual health results within minutes. This Health Assessment is not a substitute for a checkup by your doctor. It only gives you ideas about how to lower your risk of becoming sick or injured in the future. Likewise, the Health Assessment may not cover all of the health risks that could be of concern to you especially if you are pregnant or have a serious health problem. Please ask your doctor to help you understand your quiz results and to provide follow-up services as necessary. Many things like age, heredity, ethnic origin and habits affect health risks. The Health Assessment is designed to help you identify which of these factors may present health risks to you. Because of this, it is important that you answer as many questions as you can and as accurately as you can. If you do not know the answer, leave it blank. At the end of the Health Assessment, you can choose to receive communications from Customer Potential Management that are based upon your answers to the quiz. We hope that you'll agree to let us contact you with timely information about wellness and healthcare related services and programs offered by Customer Potential Management. Customer Potential Management is the sole owner of the information you provide through the Health Assessment. We will not give, sell, rent, or loan any of your personally-identifiable information you provide through this quiz to any third party, unless legally required to do so. Your personalized results will be available to you after you've completed the survey. The WebPages containing your results will expire after you close your browser. If you wish to see the results of your Health Assessment again, you'll need to retake the survey and obtain the results. Customer Potential Management Corporation (CPM) is the company that designed the Health Assessment. CPM hosts this Authorization webpage and the entire Health Assessment, analyzes your response to the quiz, and stores the survey information for Customer Potential Management. Should our agreement with CPM end, CPM has agreed to return all personally identifiable information from the quiz responses to Customer Potential Management. CPM will use reasonable measures to protect the personally identifiable information you provide through the Health Assessment from loss, misuse, and unauthorized access, disclosure, alteration, and destruction. Because no Internet transmission or computer system is ever 100% secure, however, we cannot and do not guarantee the security of the information that you transmit to CPM via this site. CPM will not use your personally-identifiable information provided in response to the quiz for any purpose not specified here. Technical staff at CPM may see your answers while helping Customer Potential Management solve a technical problem, but every CPM technical staff member with access to the quiz results signed a confidentiality agreement, as all Customer Potential Management employees who have access to the quiz results are required to do. Customer Potential Management may use and share with CPM nonpersonal, summary or aggregate data for business analysis, market analysis, communications management, research, or planning purposes. Such information may also be used to help improve this quiz. By clicking on the "I Agree" button displayed below, you represent that you are at least 18 years of age; you acknowledge that it is solely your responsibility to follow-up with the appropriate provider for any medical services you think you need as a result of taking this quiz; you release Customer Potential Management and CPM, and their respective staff, agents, and assigns, of any responsibility and/or liability pertaining to the use, administration and/or nonuse of your answers to the quiz; and you agree that you will be legally bound by and abide by this authorization as if you had signed it. Do not take this quiz if you do not agree to the terms and conditions of this authorization!
