By submitting this form and authorizing payment, you agree to the following:

1. Payment Authorization
   You authorize Lifetent Behavioral Health, LLC to charge the provided payment method for the delivery of a personalized mental health insight based on your self-assessment responses.
   Users who enter a valid and accepted coupon code at the time of submission will not be charged for the service.

2. No Cancellations or Refunds
   All purchases are final. Due to the digital nature of the service, cancellations, changes, or refunds are not permitted once the form is submitted.

3. Delivery of Service
   You will receive your mental health insight via email upon submission. It is your responsibility to provide an accurate and valid email address. We are not liable for undelivered insights due to incorrect or invalid email entry.

4. No Clinical Diagnosis or Treatment
   The mental health insight provided is for informational purposes only and does not constitute a clinical diagnosis, treatment, or medical advice. For personalized mental health care, please consult a licensed provider.

5. Privacy and Data Handling
   All information submitted through this form is securely transmitted and stored in compliance with the Health Insurance Portability and Accountability Act (HIPAA). Your personal and health-related data will be used solely for generating your mental health insight and will not be shared without your explicit consent, except as required by law.