Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at 000-000-0000.
Appears in 2 contracts
Samples: Agreement for Fees and Psychological Services, Agreement for Fees and Psychological Services
Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at 000-000-0000.
Appears in 1 contract
Samples: Agreement for Psychotherapy Services
Questions and Complaints. If you have questions about this notice, disagree with a decision I make your provider makes about access to your records, or have other concerns about your privacy rights, you may contact me Xxxxxxxxx Xxxxx at 000-000-0000.
Appears in 1 contract
Samples: Patient Services Agreement