CONTACT US TODAY!


 

 

 

 

 

 

 

Please fill out your information below and submit.  We will mail a full information packet and registration materials

 

First Name:

Last Name:

Telephone:

Address:

City:

State:

Zip:

Email:

Type of Surgical Problem/Comments/Suggestions:
 

How did you hear about our practice?

 

May we call you to arrange an appointment?:Yes  No

Please note that this is not a secure email transmission site.  We are concerned with protecting your privacy as per the federal HIPAA guidelines.  Do not transmit information of a private or personal nature.  If you are uncomfortable using this email contact form, please phone us directly at (253) 572-7120.

 


Patient Privacy Policy

The Center for Minimally Invasive Surgery, PLLC, values you as a patient and we respect your privacy. We are committed to protecting your nonpublic, personal information and to maintaining appropriate safeguards in our data systems to prevent unauthorized access to information stored. 

Patient’s medical records are not to be released to anyone or any organization without the express written consent of the patient, patient’s guardian or by court order.

Medical information may be released to your insurance company. Standard information released is diagnosis, procedure(s), operative reports and photographs as requested by your insurance company.

We will not disclose personal information to any non affiliated third parties without your prior authorization, except as necessary to conduct our business or as permitted or required by law.

We will never disclose your personal information for promotional purposes and we do not sell your information to third parties.

Before & after photographs will not be placed in our photo albums or on our website without written consent. Written releases will be effective for seven years. Patients may revoke consent in writing unless previous action as taken place. The consent has no bearing on your medical care.

E-mail is not a secure medium and third parties may intercept information exchanged via e-mail. Please consider your security before submitting personal information on the Internet.

A full copy of our office HIPAA privacy policies is available upon request.

All medical records will be kept for a period of seven (7) years.

Effective January 1, 2003

 

 
Center for Minimally Invasive Surgery
(253) 572-7120

HOME   |   OUR SURGEONS   |   GUIDELINES TO HELP YOU THROUGH YOUR SURGERY   |  FHS ADVANCED LAPAROSCOPY FELLOWSHIP COMMON SURGICAL PROCEDURES   |   HELPFUL LINKS   |    GET MORE INFORMATION/REGISTRATION   |   DIRECTIONS/MAP