Board Certified Periodontist

Patient Form

INSTRUCTIONS:

Fill out the form and submit. If you have any questions, call our office at (210) 615-1995.

Notice of Privacy Practices (HIPPA Compliance) can be viewed below. This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this Notice, please contact our Privacy Officer.

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Notice of Privacy Practices (HIPPA compliance)