Download the Consent Form
Download the Patient History Record form
Download the Pre-operative instructions form
Download the Post-operative instructions form

Privacy policy

1. All patient information is confidential.

2. No patient information will be released to anyone without permission of the patient or guardian.

3. All patients are informed that confidential information may be released, distributed, published or displayed to third parties for the following reasons: (consent is therefore obtained for these reasons)
a. Filing of insurance claims
b. For educational purposes (i.e. lectures, symposia, medical publications)
c. Filing of legal claims on patients behalf
d. Insurance precertification & predetermination
e. Compliance with state and central laws
f. Furtherance of medical care (i.e. referral to physicians, health professionals)
g. Demographic, medical surveillance and epidemiologic studies

4. Confidential information may include any of the following:
a. Demographic information
b. Photographic, x-ray or video material
c. Medical records
d. Laboratory records
e. Insurance and billing information

5. Patient consent will be obtained for all non-exempt uses of medical records.

6. Patients may request restriction of release of any or all medical records at any time by asking their physician.

7. Patients medical records are the patients property and may be inspected or copied by the patient as requested.

8. Patients may receive a paper copy of our privacy policy at any time.

9. Patients are hereby notified of there right to complain to the Department of Health and Human services if they believe their privacy rights have been infringed.

10. We may contact patients routinely for appointment reminders, billing assistance and/or transmit relevant health service information as required to patients.



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