The questionnaire surveys that have been created are for the purpose
of patient care through Houston REI in the medical practice of
Michael J. Heard, M.D. All the information submitted will be kept
strictly confidential and may be maintained on file solely through
the office of the medical provider. No information will be released
to another provider/institution for purposes of research or clinical
care without the sole written release of the parties involved who
submitted the information.

Information submitted through this website is maintained through a
secure server that cannot be viewed or accessed by outside parties.
Please be aware that although the highest confidentiality and
security of the information submitted is protected, there is always
an unknown risk to providing any personal information over the
internet. Dr. Michael J. Heard or members of his medical practice
at Houston REI do not assume responsibility for any information that
may be utilized illegally without his knowledge or consent of the
patient or parties involved for purposes other than that of the
aforementioned medical practice.

I have read the above and accept the aforementioned risks to
submitting information on this particular website.