Clients without computer access may contact us by phone at 888-260-6543
I understand that my access to genetic counseling services will not be conditional on whether I provide authorization for any requested medical record disclosure. I understand that this authorization is voluntary and that I have the right to refuse to sign it. I understand that I may inspect or receive a copy of information described in this authorization, upon payment of a reasonable fee. I understand that I have the right to revoke this authorization in writing at any time by sending written notification. I understand that a revocation will not apply to information that has already been released in response to this authorization.
I understand that any disclosure to a third person can lead to unauthorized further disclosures by that person or others, and information may no longer be protected by federal privacy regulations and other applicable state or federal laws. All information released to Genetic Counseling Services is guarded with the utmost security and discretion, but to the extent that anonymous information within needs to be reviewed by medical professionals to assist with diagnosis, testing or research options, records will be shared.