Notice Of Privacy Practice / Acknowledgement Form

Your Private Health Information is very important to us.

We have provided a link below to read and/or print our Notice Of Privacy Practice.

Notice of Privacy Practice 2014

 

If you have read this Notice and would like to print the Acknowledgement form to bring to your appointment click here.

Acknowledgment of receipt of Privacy practice 2014

If you are over 18 and would like us to be able to share information with another family member such as a parent, or guardian you can download this form which needs to be filled out and signed.

Authorization form to give out information