HIPAA-Required Patient Form   (new window will open)

Patient Consent Form for Release, Use and Disclosure of Protected Health Information.

Basically, the intent of the law is to protect the privacy of your heath information. HIPAA introduced specific rules on when, how, and what kind of information can be shared.

Patient Consent Form   (new window will open)

• You can get explanations of how your health information will be used and disclosed.
• You can ask for copies of all this information, and make changes to it.
• You can give consent to your health information sharing.
• You have the right to complain to HHS about violations of HIPAA rules.

You can get more information at the Office for Civil Rights of the United States Department of Health & Human Services.

Insurance Form   (new window will open)

This is the information we use to file insurance claims on your behalf. Please complete this form and return to us so that we can process the insurance payment information.