Privacy Policy
Privacy Policy
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED.
THE FOLLOWING ARE SOME EXAMPLES OF HOW WE MIGHT NEED TO USE YOUR INFORMATION.
Your medical information might need to be disclosed to another doctor, hospital, or other facility if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.
We may need to disclose all your information to your insurance carrier, HMO or PPO, or to your employer, if they are potentially responsible for the payment of your services.
We may need to use your information including your address, name, or phone number to remind you of an appointment, or we may need to contact you concerning your treatment. If we do contact you, we need your approval to leave a message on your answering machine, or with the person answering your home or business phone.
You have read the above information. You may or may not give us the authorization to use your medical information as listed above. if you do not give us authorization it will in no way affect the treatment we provide you, or the method we use to obtain payment for your care.
You may inspect or copy information that we use to contact you, or any information that we may have used in getting treatment for you or payment of your account.
DISCLOSURE & CONSENT FOR CHIROPRACTIC ADJUSTMENTS & CARE
TO THE PATIENT: You have a right as a patient to be informed about your condition and the recommended chiropractic adjustments and other physical procedures to be used to that you make the decision whether or not to undergo the procedure after knowing the potential risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give or withhold your consent to the procedure.