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Doctor's Visit


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: and following the prompts. 


Otherwise please fill out the digital forms and email them to

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