SCFP HIPAA FORM
Hipaa omnibus rule patient acknowledgement of receipt of notice of privacy practices and consent/ limited authorization & release form.
Click Here to Complete Form
Please save the form to your computer before filling it out.
Please note that you will need to complete a digital form. You can submit this form to us using adobe acrobat. If you do not have adobe acrobat on your computer, you can install it by clicking this link: https://get.adobe.com/reader/ and following the prompts.
Otherwise please fill out the digital forms and email them to firstname.lastname@example.org.