HIPAA Notice of Privacy Practices
You can easily fill out the form below, or if you prefer, download it as a document and complete it anytime.
KNOWLEDGEMENT OF RECEIPT OF HIPAA NOTICE OF PRIVACY PRACTICES
(”Acknowledgement”)
I acknowledge that I have received a copy of this Dental Practice's HIPAA Notice of Privacy Practices
Please Note: It is your right to refuse to sign this Acknowledgement.