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Privacy Practices

For your convenience the below documents are available to download and print. This will allow you to fill out your forms prior to your first appointment. Please remember to bring them with you on the day of your visit. Thank you!

Authorization-for-Release-of-Protected-Health-Information-English-1Download
Requested-Use-or-Disclosure-of-Protected-Health-Information-Potentially-Related-to-Reproductive-Health-Care-English-1Download
Requested-Use-or-Disclosure-of-Protected-Health-Information-Potentially-Related-to-Reproductive-Health-Care-English-2Download
Request-for-Restriction-and-Limitation-of-Protected-Health-Information-EnglishDownload
Requested-Use-or-Disclosure-of-Protected-Health-Information-Potentially-Related-to-Reproductive-Health-Care-English-3Download