I understand I have the right to:
Receive a copy of this authorization
Refuse to sign this authorization and that treatment, payment, enrollment in a health plan or eligibility for health care benefits may not be contingent on my signing this authorization
Revoke this authorization, except to the extent that the person(s) and/or organization(s) listed above have already made in reference to this authorization
Records are not kept on site. We ask for 30 days to obtain your records from storage, copy and mail/fax. There will be a $30 fee for copying and transferring records. This must be paid prior to records being pulled. This can be paid by cash in the office or by credit card.