Step 1 of 9
I understand that my care provider creates and uses a record of my health history and related information that may be used for:
My signature below authorizes the above uses of my records, consent, and treatment, and signifies that I was given a “Notice of Information Usage” or “Notice of Privacy Practices” and that this notice provides a more complex description of the ways my medical record might be used or disclosed when I registered as a patient of this clinic. I understand that the clinic’s policies about using information might change from time to time and that I can obtain another copy of the notice from Chris Taylor,M.D., PA.
To the best of my knowledge, the information provided above is accurate and complete.
1425 Rock Springs RoadHarrison, Arkansas 72601
Dr. Taylor's facility is located in Harrison, Arkansas, just 20 minutes south of Branson, Missouri