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Patient Name: ___Date of Birth: ___ / ___ / ___To protect your privacy, we ask that you complete this form, so we know the ways in which we may communicate with you regarding your health information.
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How to fill out to protect your privacy

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How to fill out to protect your privacy

01
Use strong, unique passwords for all your accounts
02
Enable two-factor authentication when possible
03
Be cautious when sharing personal information online
04
Regularly update privacy settings on social media platforms
05
Use a Virtual Private Network (VPN) when browsing the internet

Who needs to protect your privacy?

01
Everyone who values their privacy and wants to avoid identity theft or unauthorized access to personal information
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Protecting your privacy refers to safeguarding your personal information from unauthorized access, use, or disclosure.
Individuals and organizations that handle personal data must adhere to privacy laws and regulations, ensuring they are protecting the privacy of individuals.
To protect your privacy, ensure that any forms or applications requesting personal information are filled out carefully, providing only necessary information, and reviewing privacy settings on platforms you use.
The purpose of protecting your privacy is to maintain the confidentiality, integrity, and security of personal information, thereby preventing identity theft and misuse.
Information that may need to be reported includes any incidents of data breaches, unauthorized access to personal data, and compliance with relevant privacy laws.
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