Our Notice of Privacy Practices
Please read and review our privacy practices.

Acknowledgement & Consent to our Privacy Practices 
Please print this form and bring to your first appointment with our office. Signing this form acknowledges that you have read & undertand our privacy practices.

Request for Restriction on Use/Disclosure of Medical Information or Confidential Communication
Use this form if you would like to allow our office to discuss your healthcare with anyone besides yourself. For instance: If you have a caregiver, or a family member, that assists you in scheduling appointments, making healthcare decisions or other aspects of your care, this form is necessary to allow WHCSO to communicate with that individual. This form can also be used to restrict certain aspects of communication as well.