The following forms are for your benefit. Please

download the form or copy and print and bring this

form with you at your next scheduled visit.

NOTICE OF PRIVACY POLICY

This policy shows how your medical information may

be used or disclosed by our office.

AUTHORIZATION FOR RELEASE 

Please use this form if you need to have records

transferred to someone else.

AUTHORIZATION  FOR TRANSFER

Use this form to have your child's records sent to us.

PATIENT RIGHTS AND RESPONSIBILITIES

This policy is to inform the patient of their rights

and responsibilities as a patient