CC Elite MultiChannel Web Chat Example

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	Current Call Back Phone Number: (numeric) *
	Email Address:
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	Relation:
	Subject:

	Subject Details:
	The information you provide in this chat will be kept confidential, except to meet legal obligation (requirements of law and DoD or military regulations), to prevent harm to self or others, which includes suicidal thoughts or intent, a desire to harm oneself, domestic violence, child abuse or neglect, violence against any person, including sexual assault involving service members, and any present or future illegal activity. For more information on how this information may be used or shared, please review our Privacy Act Statement by visiting: (https://www.militaryonesource.mil/legal-security/privacy-policy/)
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