• Authorization to Release Information

    Nicodemus M. Watts, MD, DFAACP

  • Federal law requires your specific authorization for release to appropriate parties any information about your treatment for certain conditions. Please check and sign all pertinent statements below giving your permission to communicate with the following individual, agency, or organization on your behalf:

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  • I hereby authorize:

    Nicodemus M. Watts, MD, DFAACAP
    3760 Convoy Street, Suite 113 
    San Diego, CA 92111-3743 
    Phone: (858) 598-5207

  • _____________________________________________________________

    I understand that I may revoke this consent at any time by providing written notice. After one year this consent automatically expires. I have been informed what information will be given, its purpose, and who will receive the information.

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