Please note that this form is unsecured and designed to gain the most basic of New Patient information so that we may reach-out to you in a follow-up email/phone-call.
In our offices, we follow strict patient privacy laws by policies detailed in the The Health Insurance Portability and Accountability Act (HIPAA). No patient or personal information (outside of data retained from this form) is stored, or available via Web/Internet Services.
For any further questions on how we use and protect your privacy through our website - please read our Privacy Policy.
In our offices, we follow strict patient privacy laws by policies detailed in the The Health Insurance Portability and Accountability Act (HIPAA). No patient or personal information (outside of data retained from this form) is stored, or available via Web/Internet Services.
For any further questions on how we use and protect your privacy through our website - please read our Privacy Policy.
