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Patient Forms

HIPAA Acknowledgement

HIPAA ACKNOWLEDGEMENT

Acknowledge receipt of the Notice of Privacy Practices. 
Designate individuals to receive your health information.
Choose how to receive office communications.

Sliding Fee Discount Application

SLIDING FEE DISCOUNT APPLICATION

G&G Healthcare does not refuse service based upon inability to pay. Please complete this application to see if you qualify for this program.

Medical Records Release Form

MEDICAL RECORDS RELEASE FORM

Authorize G&G Healthcare to request your medical records from another healthcare facility/clinic.

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