Privacy Statement:
At Nepenthe Wellness Center, we are committed to protecting the privacy and confidentiality of your information. The personal and medical information collected on this referral form is used solely for the purpose of facilitating patient care and communication between providers.
By submitting this referral form, you acknowledge and consent to the following:
1. Use of Information: The information provided on this form will be used by Nepenthe Wellness Center staff to process and fulfill the referral request, including scheduling appointments and coordinating patient care.
2. Confidentiality: We maintain strict confidentiality standards and will not disclose your information to third parties unless required by law or authorized by you.
3. Security Measures: We employ industry-standard security measures to safeguard your information against unauthorized access, disclosure, alteration, or destruction.
4. Retention: Your information will be retained in accordance with applicable laws and regulations governing medical records and patient information.
By submitting this referral form, you agree to the terms outlined in this privacy statement. If you have any questions or concerns about our privacy practices, please contact us at 512.986.7723.
Thank you for trusting Nepenthe Wellness Center with your referral. We are committed to providing you and your patients with the highest level of care.