Phone: (304) 596-5780 Fax: (304) 596-5781 INFORMED CONSENT AND PATIENT SERVICES AGREEMENTInformed Consent and Patient Services Agreement • March 16th, 2016
This document (referred to as “the Agreement”) contains important information about our professional services and business policies. It also contains summary information about the Health Insurances Portability and Accountability Act (HIPPA), which is a federal law that provides privacy protections and patient rights regarding the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and healthcare procedures. HIPAA requires that I provide you with a Notice of Privacy
