HIPPA

Due to the Health Insurance Portability and Accountability Act,legislation which protects patient's information laws, we must have your
written authorization to release your medical and billing information to a person/body (e.g., family, insurance companies, health care professionals, legal personnel, etc.) other than yourself. Please understand that your information may need to be discussed with your current physician and/or any other medical facility in regards to the scheduling of procedures, testing or surgery. A signed release will be valid for one year from the date of signing.