This form provides you (client) with information that is additional to that detailed in the Notice of Privacy Practices.June 20th, 2023
FiledJune 20th, 2023CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law. The provisions explaining when the law requires disclosure were described to you in the HIPAA Notice of Privacy Practices that you received with this form.