Bucks County Anxiety Center
This information is requested in the event of a psychiatric emergency. No information will be given to anyone about your treatment status or appointments without your expressed permission.
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Because some topics are hard to bring up, we ask these same questions of everyone.
Please indicate if you’ve ever done any of these activities, how often, and whether it’s happening now or happened in the past.
I hereby acknowledge that I can print off a copy of Bucks County Anxiety Center’s Privacy Practices from the website. All of the providers at Bucks County Anxiety Center follow the same privacy/HIPAA practices.
The practice HIPAA policy is available online at https://buckscountyanxietycenter.com/hipaa 24/7 for your reference.
In addition, I hereby consent to the use and disclosure of mine and/or my child’s personal health information for the purposes of treatment, payment, and health care operations.
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