PRIVACY PRACTICES STATEMENT
HIPPA
ACKNOWLEDGEMENT OF RECEIPT

I acknowledge that I have access to a copy of the Notice of Privacy Statement (HIPPA) from this office

I have read this Privacy Statement and any questions I had, have been answered by the office staff.

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I ACCEPT. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.

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Hippa

Farmington Family Dental

PRIVACY PRACTICES STATEMENT HIPPA ACKNOWLEDGEMENT OF RECEIPT

I acknowledge that I have access to a copy of the Notice of Privacy Statement (HIPPA) from this office

I have read this Privacy Statement and any questions I had, have been answered by the office staff.

PRIVACY PRACTICES STATEMENT
HIPPA
ACKNOWLEDGEMENT OF RECEIPT