Patient Forms And
Confidentiality Notices

Registration Forms

• New Patient Questionnaire
• Financial Acknowledge
• Patient Registration
• Medical Records Release
• Patient HIPAA Acknowledgement and Consent

Patient Rights & Responsibilities

We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.

• Patient Rights & Responsibilities
• Derechos y Responsabilidades del Paciente

Privacy Notices

This privacy notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully.

• Notice of Privacy Practices (provided for you at your first visit)
• Aviso Sobre Las Practicas De Privacidad (proporcionada por usted en su primera visita)