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You can print and fill out this form ahead of time and bring it to the doctor’s office when you come in for your appointment so you don’t have to wait and fill it in the office.
Notice of Privacy Practices
To view our office’s privacy policies, please click here.
Authorization of Release Form
To release your medical record to or from this office, please complete this form and either:
– Bring your photo ID and the form to our office, have a staff in our office to witness your signature on the form.
– Have the office you are releasing the form to or from fax us an authorization form along with your copied ID.
To save a pdf file on your computer, right click the link or image and click on “Save Link As.”