Acknowledge Privacy Practices Form

Save time when you come to our office for your appointment by filling out this form in advance. You can either fill it out on your computer or print it out and fill it in by hand.


  • Click on the form to open it.
  • Fill out the form.
  • Select the print button at the bottom of the form to print a copy.
  • Sign the printed form and bring it to our office when you come for your appointment.
  • If you want to save a digital copy on your computer, click the save button at the bottom of the form.

Note – This form requires the free Adobe Acrobat reader. If you do not have Acrobat Reader installed on your computer you can get_adobe click here to download and install the free reader.