Services Agreement and Consent FormServices Agreement and Consent • July 3rd, 2024
This document (hereafter referred to as “Agreement”) contains important information about our professional services and business policies. It also contains brief information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides certain privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices (referred to as Notice) for use and disclosure of your PHI. The Notice, which is made available to you along with this Agreement, explains the application of HIPAA to your personal health information in greater detail. In order provide services to you, we require your signature acknowledging that we have provided you with this information and that you have given your informed consent to the services and the practices described in this document. When you sign this document, it will represent an Agreement between us. You may
