About Our Privacy Practices

Request for Accounting of Disclosures

You have the right to know how your information has been used. Print out a request form to mail to us here.

Request to Access Form

You may request to review the personal health information held about you in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Print out a request form to mail to us here.

Request for Alternate Means of Communication Form

You may request that your protected health information be sent to you via alternative means or to an alternative location. Print out a request form to mail to us here.

Request to Amend/Correct Protected Health Information

If the health information held about you is incomplete or incorrect, you may request to amend/correct it here. Print out a request form to mail to us here.

Request Restrictions on Personal Health Information
Use and Disclosure

You may request to restrict the use and disclosure of your protected health information. Print out a request form to mail to us here.

PHI Release Authorization (Personal Representative)

You may wish to have a spouse, parent, adult child, or caregiver have access to your medical and health information on an on-going basis to assist with your care and maintaining your information. Print out an authorization form to mail to us here.