I understand that:
1. I understand that signing this authorization is voluntary and that treatment or payment for treatment cannot be conditioned on the signing of this authorization.
2. I understand the information disclosed under this authorization might be re-disclosed by the recipient.
3. I have the right to revoke this authorization at any time, in writing, to Luna Lactation and Wellness.
4. I authorize and request the disclosure of all protected medical information inlcuing but not limited to chart notes, labs, care plans, health records, medication lists, etc.