We will leave appointment reminder messages to your voicemail but will not leave detailed personal information.
Pneumococcal and Influenza Vaccine:
I acknowledge that Michael C. Speck, M.D., P.A. has made available to me a copy of the Notice of Privacy Practices (HIPAA). This notice describes how this office may use and disclose my protected health information. I understand that I can obtain a complete copy upon my request. A copy is also available at gillespiecountyurology.com
This release of information will remain in effect until terminated by the patient in writing.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.