The Privacy Act of 1977 was established to protect your privacy and to give you security in knowing that
when you come to our office, your medical and financial affairs will not be disclosed with anyone without
your permission. This includes your spouse and/or family member(s).
It is a felony for our staff to give out this information without your written consent. Please take a
moment and list anyone whom you would like to give us permission to discuss your personal health
Thank you for your assistance with this matter.