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HIPAA Privacy

HIPAA Privacy Notice


Click below to download the HIPAA PRIVACY NOTICE and then submit the acknowledgement form at the bottom of this page.

HIPAA Privacy Notice


Please note, in order to download the HIPAA PRIVACY NOTICE, you will need the Adobe Reader.

Although most computers already have an Adobe Reader installed, you may access the free Adobe Reader Download here: Adobe Reader

 

 

Please Submit Acknowledgement

NOTICE OF PRIVACY PRACTICE (HIPAA) PATIENT ACKNOWLEDGEMENT
Please note that all fields followed by an asterisk must be filled in.

Healthy Insights, Inc.
5150 Linton Blvd., Suite 310
Delray Beach, FL 33484
Phone: 561-498-8585 Fax: 561-499-8585
First Name*
Last Name*
Date*
Acknowledgement*
I acknowledge receipt of a copy of Healthy Insights Inc.’s notice of Privacy Practice. (HIPPA)
Electronic Signature
Please enter your name &
todays date to submit this form.
Thank You!*