NEW PATIENT REGISTRATION

PAST HISTORY

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT OF RECEIPT

Thank you for visiting our website and reviewing our privacy policy. We respect the right to privacy for all our visitors. Personal information sent to us, such as names, addresses, phone numbers, email addresses, etc., is covered by the government’s HIPAA Medical Privacy Act.

When submitting personal information for your medical records, you can be assured of the following:

• The information will not be shared with anyone not on our staff or involved in your medical care.
• Your email address will not be provided to third parties, unless we are required to do so by law.
• We will not create individual profiles with the email information you provide.
• We do not collect information for commercial marketing.

Your information will be used to:

• Consider your suggestions.
• Possibly respond directly to you for clarification.
• Process your request for materials, if you make one.
• Try and answer your questions if you ask them.
• Register you for an event, if you request it.

As a courtesy, this site provides links to other sites. These sites are not under our control, and we are not responsible for the contents of any linked sites, or the security and privacy practices of those sites.

Information provided on this site is not meant to replace the advice of medical professionals. Please check with your health care provider for advice or guidance specific to your case.

If you have any questions about our site or our privacy policy, please contact us.