HIPAA Acknowledgement

The HIPAA Acknowledgement form should be signed by all new patients. If you have questions about the form, please call our office or speak with someone at your appointment.

Download HIPAA Acknowledgement Form

The HIPAA Personal Representative Designation form should be used by patients who wish to designate individuals who can receive information about the care received at our office. This includes financial information. Oftentimes patients chose to designate their spouse, parents or children, however choosing a representative is optional and this form is not required.

Download HIPAA Personal Representative Designation