Information we collect
When you submit an appointment request, we collect the contact details and visit preferences you provide so the clinic can respond to you. The intake form also includes an optional symptom screening — general symptom areas, approximate duration, surgery status, prior therapy, and your goals. Every one of those fields is optional, and you may choose to discuss them at your visit instead.
The website intake form is not a medical record and is not a substitute for the secure history we take during your evaluation. Please keep entries general and avoid test results, diagnoses, or detailed health history.
How it is used
Information submitted through this website is used to respond to your request and schedule care. It is not sold. Website forms are not a secure medical record, which is why we ask you to keep messages general.
Protected health information
Patient records created during care are handled under applicable healthcare privacy law and the practice's Notice of Privacy Practices, which is provided at your first visit.
To update: Full privacy policy language, HIPAA Notice of Privacy Practices, analytics and cookie disclosures, and data retention terms should be reviewed by legal counsel before launch.