Your personal information is very important to us. We make every effort to ensure your records and information are kept safe and confidential. To help prevent misuse of your personal information, one of the measures we take includes taking a picture of each of our patients. This picture is for identification purposes only and its use will be confined to your personal records. We appreciate your understanding and cooperation with this.
You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.