HIPAA Client Information Release Form
In general, the HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy rule gives individuals the right to request confidential communications or that a communication of private health information be made by alternative means, such as sending correspondence to the patient’s office instead of their home. Level One Training and Fitness may occasionally call, text, and/or email you regarding an appointment, etc. Please let us know which form(s) of communication you would prefer to be contacted by.

I understand that if this form is returned WITHOUT a signature, Level One Training and Fitness will only be able to discuss my information with me and only me.
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