Print off the acknowledgement and please read our Privacy Rights and sign and date where indicated. Bring the signed acknowledgement to your appointment.
Please read through our Financial Policy to understand your payment options and how we bill your charges.
Request For Release of Medical Information
Please print the form and fill out required information. Be sure to sign and date the form. Mail or hand carry to our office.
Authorization of Use/Disclosure of Protected Health Information
If you would like us to share your information with another person please print and fill out this form. Be sure to sign and date the form then mail or hand carry to our office.
Please fill out form, sign and date and return to our office.
Please fill out form, sign and date and return to our office.
Please fill out form, sign and date and return to our office.
