REGISTRATION SHEET AND CONSENT FOR TREATMENT
ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES
COPY OF OUR NOTICE OF PRIVACY PRACTICES
Monday – Friday,
Ridgeland and Jackson
For more information
or to set up an
call (601) 898-7520 or
Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.
Please know all responses will be kept confidential and anonymous.
NOVEL CORONA VIRUS (COVID-19)
WHAT DO I DO IF I MIGHT HAVE COVID-19
If you are experiencing symptoms of respiratory illness (fever, coughing or shortness of breath) or answer yes to either of the following questions, contact your primary care physician for guidance.
If you do not have one, call one of the numbers below to schedule an appointment with a primary care physician.
Have you been in contact with anyone confirmed or suspected of having coronavirus/COVID-19 in the last 14 days?
In the last 14 days, have you traveled to an area with sustain community transmission of COVID-19 (Europe Asia New Orleans or others)?