Patient Forms
Notice of Privacy Practices
How health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Authorization for Release of Medical Information
Authorize the disclosure of your health information to a designated individual, company, agency, or facility
Authorization and Consent for Treatment
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Preferred Contacts
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
Financial Policy
This form advises patients of their financial responsibility for all medical services received without regard to insurance eligibility or coverage
determinations.
Language Services
Get covered for the treatments you deserve:
