Patient/GIC Privacy Documentation

Please select from the form(s) below. Open that form in your internet browser (if you receive a password box, simply click cancel) and print. After printing you may sign and return the document(s) to our office at your next visit.

If you wish to download the documents, simply right click the form you wish to save, select save source as and save the selected document to a familiar place on your computer.

At your convenience open that document from your computer and print. Sign your forms and return them to our office at your next visit.

Acknowledgement of Receipt of Notice of Privacy Practices
Notice of Privacy Practices of GIC
Patient Privacy Compliant Form
Request to Access and Inspect/Receive a Copy of Protected Health Information
Patient Limit Request Form