211 Old Hickory Blvd, Bellevue, TN 37221
(615) 646-5686


Your information, your rights, our responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.




Our goal is to provide and maintain a good physician-patient relationship. By informing you in advance of some of our policies, it allows for good communication and enables us to achieve our goals. Please read each section carefully. If you have any questions, please do not hesitate to ask a member of our staff.

  1. We are concerned with protecting your privacy. While the law requires us to give you this disclosure, please understand that we have, and always will, respect the privacy of your health information.
  2. Your health care provider and members of the staff may need to use your name, address, phone number and your clinical records to contact you with appointment reminders, information about treatment alternatives or other health related information that may be of interest to you.
  3. You may restrict the individuals or organizations to which your health care information is released or you may revoke your authorization to us at any time; however, your revocation must be in writing and mailed to us at our office address. We will not be able to honor your revocation request if we have already released your health information before we receive your request to revoke your authorization. In addition, if you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information if they decide to contest any of your claims, unless you have paid your out of pocket costs in full.
  4. Information that we use or disclose based on the authorization you are giving us may be subject to redisclosure by anyone who has access to the reminder or other information and may no longer be protected by the federal privacy rules. You have the right to refuse to give us this authorization. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
  5. This authorization will expire seven years after the date on which you last received services from us. Ultimately, we want to protect you and your health information as enforced by the Department of Health & Human Services.