To Our Valued Patient:

As mandated by Federal Law, Altitude Oral Maxillofacial Implant Center has made me aware of the HIPAA (Health Insurance Portability and Accountability Act) Laws. HIPAA Privacy Posters are posted in the office, and I have taken the time to read and understand that my personal health information will be used only for the purposes of providing treatment, obtaining payment from my insurance company, and conducting health care operations. I understand that I have the right to obtain a copy directly from Altitude Oral Maxillofacial Implant Center at any time.

Please be advised that in the event of surgery, whoever has escorted you may be exposed to your health information and post-op instructions.

Please download, print, fill out, and return the following PDF to us.