Skip to main content
Home » Privacy Policy » ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

  • I HAVE READ AND UNDERSTAND THIS FORM. I AM SIGNING IT VOLUNTARILY.

  • MM slash DD slash YYYY
  • If you are signing as a personal representative of the patient, please indicate your relationship

x
Please welcome & meet Dr. Darrin Shandley, O.D., the new owner of TSO Portland!

Schedule an Appointment