You have the right to read our Notice of Privacy Practices before you sign this Consent.
Our Notice provides a description of our treatment, payment activities and healthcare operations, of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. A copy of our Notice accompanies this Consent. We encourage you to read it carefully and completely before signing the Consent.
Click here to read our Privacy Practices
I acknowledge that I have received a copy of this office’s Notice of Privacy Practices: