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This is a copy of the information we give our client when they come in for an appointment. You can download the PDF and print it out. This information is including with patient information package.

Notice of Privacy Practices (HIPAA form)

The privacy of your medical information is important to us. We create a record of the care and services you receive at our clinic. Any other personal information you disclose to us is also confidential.

You have a right to a copy of our Notice of Privacy Practices. We reserve the right to revise our Notice of Privacy Practices at any time and a revised copy is available at our office. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us at the address provided on the letterhead above.

For Treatment: We may use health and medical information about you to provide you with natural healing treatment or services. We may disclose information about you to doctors, nurses, technicians, or other health practitioners to assist them in treating you. As an example, your doctor may call us or we may write a report to your doctor.

Communication: In serving you, we may have to contact your home by phone, mail, or Internet to confirm appointments, or discuss your care. We will not leave personal information on your message machine.

Billing: We may have to send treatment notes (SOAP notes) to insurance companies. They may send you copies of bills with medical information.

Legal: We may have to release office notes to lawyers if you are involved in a legal case.

Governmental Agency: Under certain circumstances we may have to disclose information to a governmental agency, law enforcement, or to a court or administrative body through subpoena.

We are giving you this notice because it is required by law. We have always had strict confidentiality practices at our clinic to ensure our patients privacy. If you have any questions about this Notice of Privacy Practices please ask us.

By signing this form you are giving your consent for us to use your medical information in your treatments.

You can download the patient package here.

Click to see the Herbal Healing: Informed Consent

Click here to see the Insurance: Informed Consent

These forms are included with the patient package download