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Contact patient relations

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Contact Patient Relations
Contact Patient Relations

Message patient relations

To protect your privacy, do not submit personal medical information in this unsecured form. We are not able to provide medical advice through this form. We do not accept solicitations and we are not able to promote outside events. If this is an emergency, please call 911 or visit a hospital emergency room. 

* Asterisk indicates a required field. Response times to this form may vary depending on volume. 

Please let us know your concern

Note: Messages can include a maximum of 4,000 characters. Anything more than 4,000 characters will not be submitted with your message.

Privacy Notice
Your privacy is important to us. This form is designed to allow you to ask questions or file complaints regarding your healthcare services. We are committed to protecting your personal information in accordance with HIPAA and CMS guidelines.

Information Collection and Use
We collect personal information such as your name, contact details, and health insurance claim number to address your questions or complaints effectively. This information will be used solely for the purpose of resolving your inquiries and improving our services.

Data Security
All information submitted through this form is encrypted and stored securely. Access to your data is restricted to authorized personnel only. We implement strict security measures to protect your information from unauthorized access, alteration, or disclosure.

Your Rights
You have the right to access and ensure correction of your personal information. If you have any concerns about how your data is being handled, please contact us.

Potential Risks
While we take extensive measures to protect your information, there are inherent risks associated with online data transmission. Despite our best efforts, we cannot guarantee absolute security. By submitting this form, you acknowledge and accept these risks.

Consent
By submitting this form, you consent to the collection and use of your information as described in this notice. You also acknowledge that you have read and understood our privacy practices.