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.