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Clayton Medical PC
3 Lyon Place. Oldenburg, NY 13669
Health Connections Consent Form1. How Your Information Will be Used. Your electronic health information will be used by Clayton Medical PC only
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01
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04
Fill out your personal information such as name, date of birth, address, and contact details.
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Provide your consent by checking the appropriate boxes or filling in the necessary information.
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If there are any specific sections or fields you are unsure about, seek clarification from the healthcare provider or organization.
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Submit the form to the designated recipient or follow the instructions given by the healthcare provider or organization.
Who needs health-e connections consent formdocx?
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Any individual who wishes to participate or access healthcare services through the health-e connections program may need to fill out the health-e connections consent formdocx.
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