HIPAA requires the use of a form like this, which enables your patients to consent to the use and disclosure of their protected health information to carry out treatment, payment activities and health operations. Be sure to place a copy of it in the packet of forms that you give to all new patients (and returning patients that do not have the form on file).

Includes your practice name and contact information imprinted in black ink.

Also available as a 2-part form; see related products below.

8-1/2” x 11”; 20# white bond; 1000 per carton.