Your Right to Revoke Consent
You have the right to revoke this Consent by giving us written notice of your revocation. We retain the right to decline to treat you or to continue treatment should you choose not to sign this Consent or choose to revoke it at a later time.
You are entitled to a copy of this Consent after it is signed. We support your right to the privacy of your health information. If you have any further questions about our Health Information Privacy Policies and Procedures, please inquire at the reception desk.